What is the clinical evidence from this study?

Study design: Observational. Population: Major cardiac surgery (n=54). Intervention: ClearSight noninvasive arterial pressure measurement vs. Invasive arterial pressure measurement. Primary outcome: Mean difference in mean arterial pressure (MAP) (MD -5.47 mmHg, 95% CI -27.20 to 16.26, p=<0.05).

July 1, 2021Open Access

Noninvasive continuous arterial pressure monitoring during anesthesia induction in patients undergoing cardiac surgery

Q: What are the key findings of this study?

Noninvasive arterial pressure measurement using ClearSight during anesthesia induction for cardiac surgery showed a mean difference of -5.47 mmHg for mean arterial pressure compared to invasive measurement.

Key Result

Noninvasive arterial pressure measurement using ClearSight during anesthesia induction for cardiac surgery showed a mean difference of -5.47 mmHg for mean arterial pressure compared to invasive measurement.

Study Design

Type

Observational (n=54)

Multicenter

Structured PICO

Does noninvasive continuous arterial pressure monitoring using ClearSight accurately reflect invasive arterial pressure measurements during anesthesia induction in patients undergoing major cardiac surgery?

Population

54 adult patients undergoing elective major cardiac surgery with extracorporeal circulation, monitored simultaneously with invasive and noninvasive arterial pressure measurement during anesthesia induction.

Intervention

Noninvasive continuous arterial pressure measurement using the ClearSight™ vascular-unloading technique (finger cuff placed ipsilateral to the arterial catheter).

Comparator

Invasive arterial pressure measurement via radial artery cannulation (reference method).

Outcome

Agreement between noninvasive and invasive arterial pressure measurements (systolic, diastolic, mean arterial pressure, and heart rate) during induction of anesthesia over a mean time period of 27 minutes.surrogate

Noninvasive continuous arterial pressure monitoring using ClearSight provides acceptable accuracy for mean arterial pressure compared to invasive monitoring during anesthesia induction in major cardiac surgery.

Main Result

Mean Difference: -5.47 (95% CI -27.2–16.26)

p-value: p=<0.05

Limitations

Potential impact on perfusion distal to the catheter due to ipsilateral placement of the noninvasive cuff
Low sampling frequency (1 value per minute) may not fully reflect rapid blood pressure changes
Invasive radial artery pressure may not optimally reflect brachial artery pressures calculated by the ClearSight system
Lack of accuracy using the volume clamp method in situations with low perfusion, peripheral vasoconstriction, or chronic vascular disease

Abstract

Objective: In this study we compared noninvasive arterial pressure measurement using ClearSight™ vascular-unloading-technique (Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurement during induction of anesthesia undergoing mayor cardiac surgery. Design: Prospective, monocentric. Setting: University hospital. Participants: 54 patients undergoing mayor cardiac surgery. Interventions: During induction all patients were simultaneously monitored with invasive (reference method) and noninvasive arterial pressure measurement (test-method) over a mean time period of 27 minutes. Measurements and Main Results: We observed slightly lower systolic and mean arterial pressures noninvasive than invasive. For systolic arterial pressure the mean of the differences was -18,05 mmHg (p < 0,05, SD ±16,78 mmHg), the mean arterial pressure MAP -5,47 mmHg (p < 0,05, SD ±11,08 mmHg) and for diastolic pressure -1,09 mmHg (p < 0,05, SD±11,15 mmHg),. The mean of the differences in heartrate was 1,15 (p < 0,05, SD±6,9 mmHg). When considering all measured values of the invasively measured MAP and the ClearSight ™ -MAP at the same timestamp over the recording interval, an almost identical progress can be seen that indicates a sufficient mapping of the hemodynamic changes. The percentage error for mean arterial, systolic and diastolic pressure measured by ClearSight™ amounts to 25,95 %, 26,77 % and 34,16 %, respectively. Conclusions: We conclude that ClearSight ™ is a good option for hemodynamic monitoring during induction of anesthesia. Taking into account the limitations, non-invasive arterial blood pressure measurement offers sufficient security to safely initiate anesthesia, especially when MAP is of particular interest. The use of non-invasive arterial blood pressure measurement with ClearSight ™ during induction of anesthesia in patients scheduled for major cardiac surgery is reliable and easy to use.

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