Key result
Arterial pressure waveform derived cardiac index (APCI) showed a bias of 0.095 L/min/m2 with limits of agreement from -2.387 to 2.557 L/min/m2 compared to PACI, and a mean error >30%, indicating it is not reliably comparable during cardiac surgery with moderate hypothermic cardiopulmonary bypass.
Why the study?
Does arterial pressure waveform derived cardiac index (APCI) from the radial artery provide reliable hemodynamic monitoring compared to pulmonary artery catheter derived cardiac index (PACI) in patients undergoing cardiac surgery with hypothermic cardiopulmonary bypass?
Observational (n=15)
Does arterial pressure waveform derived cardiac index (APCI) from the radial artery provide reliable hemodynamic monitoring compared to pulmonary artery catheter derived cardiac index (PACI) in patients undergoing cardiac surgery with hypothermic cardiopulmonary bypass?
Radial artery pressure waveform derived cardiac index is not reliably comparable to pulmonary artery catheter thermodilution for hemodynamic monitoring during cardiac surgery with moderate hypothermic cardiopulmonary bypass.
Answers are grounded in this paper and cite their sources.
APCI should not replace PACI for cardiac index monitoring during hypothermic CPB; this Level 3 evidence leaves open needs for refined waveform validation.
BACKGROUND: Discrepancy of central-peripheral arterial pressure after cardiopulmonary bypass may affect the reliability of arterial pressure waveform derived cardiac index (APCI) monitoring. METHODS: In 15 elective cardiac surgeries employing moderate hypothermic cardiopulmonary bypass (CPB), APCI from radial arterial cannula and pulmonary artery catheter derived cardiac index from thermodilution method (PACI) were measured 1) after anesthesia induction (T1), 2) before CPB (T2), 3) immediately after CPB (T3) and 4) 1 hour after CPB (T4). APCI and PACI were analyzed by using the Bland-Altman analysis. RESULTS: Biases of APCI and PACI at T1, T2, T3 and T4 were 0.093 L/min/m2, -0.053 L/min/m2, 0.485 L/min/m2 and -0.09 L/min/m2, respectively. The limits of agreement (2 SD) at T1, T2, T3 and T4 were from -2.285 to 2.471 L/min/m2, -2.475 to 2.369 L/min/m2, -2.255 to 3.225 L/min/m2 and -2.609 to 2.423 L/min/m2, respectively. Bias of APCI and PACI during entire period (T1-T4) was 0.095 L/min/m2 and 2 SD was from -2.387 to 2.557 L/min/m2. However, mean error % (2 SD/mean) of APCI at T1, T2, T3, and T4 were greater than 30%. CONCLUSIONS: Our results were not able to show that APCI measured from radial artery is comparable to PACI for hemodynamic monitoring during cardiac surgery employing moderate hypothermic CPB. Considering the limitations of PACI as a gold standard of hemodynamic monitoring in a certain clinical circumstance, further investigation employing other monitoring method than PACI may be followed to get more definitive conclusion.
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Jung et al. (2009) conducted an observational in Elective cardiac surgery employing moderate hypothermic cardiopulmonary bypass (n=15). Arterial pressure waveform derived cardiac index (APCI) vs. Pulmonary artery catheter derived cardiac index (PACI) was evaluated on Agreement between APCI and PACI (Bias and Limits of Agreement) (Bias 0.095 L/min/m2, 95% CI -2.387 to 2.557). Arterial pressure waveform derived cardiac index (APCI) showed a bias of 0.095 L/min/m2 with limits of agreement from -2.387 to 2.557 L/min/m2 compared to PACI, and a mean error >30%, indicating it is not reliably comparable during cardiac surgery with moderate hypothermic cardiopulmonary bypass.
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