Key result
Fourth-generation FloTrac/Vigileo shows poor cardiac output agreement with PACs, yielding a ~54% error rate.
Why the study?
The effect of the updated cardiac output algorithm on the accuracy of fourth-generation FloTrac/Vigileo system continuous cardiac output measurement in liver transplantation is unclear.
Does the fourth-generation FloTrac/Vigileo system provide accurate continuous cardiac output measurements compared to a pulmonary artery catheter in adult liver transplant recipients?
Observational (n=20)
Single-blind
No
Does the fourth-generation FloTrac/Vigileo system provide accurate continuous cardiac output measurements compared to a pulmonary artery catheter in adult liver transplant recipients?
The fourth-generation FloTrac/Vigileo system shows low agreement with pulmonary artery catheter measurements for continuous cardiac output in adult liver transplant recipients, suggesting it may not be a reliable alternative in this setting.
Should not yet replace pulmonary artery catheter for cardiac output in liver transplant recipients; leaves open need for further device validation.
In liver transplantation for end-stage liver failure, monitoring of continuous cardiac output (CCO) is used for circulatory management due to hemodynamic instability. CCO is often measured using the minimally invasive FloTrac/Vigileo system (FVS-CCO), instead of a highly invasive pulmonary artery catheter (PAC-CCO). The FVS has improved accuracy due to an updated cardiac output algorithm, but the effect of this change on the accuracy of FVS-CCO in liver transplantation is unclear. In this study, we assessed agreement between fourth-generation FVS-CCO and PAC-CCO in 20 patients aged ≥ 20 years who underwent scheduled or emergency liver transplantation at Kyoto University Hospital from September 2019 to June 2021. Consent was obtained before surgery and data were recorded throughout the surgical period. Pearson correlation coefficient (r), Bland–Altman and 4-quadrant plot analyses were performed on the extracted data. A total of 1517 PAC-CCO vs. FVS-CCO data pairs were obtained. The mean PAC-CCO was 8.73 L/min and the mean systemic vascular resistance was 617.5 dyne·s·cm-5, r was 0.48, bias was 1.62 L/min, the 95% limits of agreement were − 3.04 to 6.27, and the percentage error was 54.36%. These results show that agreement and trending between fourth-generation FVS-CCO and PAC-CCO are low in adult liver transplant recipients.
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Murata et al. (2022) conducted an observational in End-stage liver failure requiring liver transplantation (n=20). Fourth-generation FloTrac/Vigileo system (FVS-CCO) vs. Pulmonary artery catheter (PAC-CCO) was evaluated on Agreement between FVS-CCO and PAC-CCO (bias and 95% limits of agreement) (MD 1.62 L/min, 95% CI -3.04 to 6.27). The fourth-generation FloTrac/Vigileo system showed poor agreement with pulmonary artery catheter continuous cardiac output in adult liver transplant recipients, with a mean difference (bias) of 1.62 L/min and a percentage error of 54.36%.
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