A Critical Review of the Ability of Continuous Cardiac Output Monitors to Measure Trends in Cardiac Output

Critchley, Lester A. H.; Lee, Anna; Ho, Anthony M.‐H.

doi:10.1213/ane.0b013e3181f08a5b

Cited by 453 publications

(463 citation statements)

References 69 publications

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“…6 As no CO monitoring tool can currently replace thermodilution, 21 the ability of new mini-and noninvasive CO monitors to assess trends could be more important at the bedside than their accuracy in measuring absolute values of CO under stable hemodynamic conditions. 18 The esCCO device fulfills these specifications and thereby justifies the main objective of the present study.…”

Section: Discussionsupporting

confidence: 64%

“…17 Trends were analyzed using polar plotting of CO changes among consecutive time points, as previously described. 18,19 A P value of \ 0.05 was considered to be statistically significant and all P values were two-tailed. Statistical analyses were performed using MedCalc Ò Software bvba version 12.5.0 (Mariakerke, Belgium) and Deltagraph Ò version 5.6 (RockWare Inc., Golden, CO, USA).…”

Section: Discussionmentioning

confidence: 99%

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The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Estimated continuous cardiac output (esCCO) is a new and noninvasive cardiac output (CO) monitoring device using pulse wave transit time. The aim of this study was to assess rapid changes in CO using esCCO (DCO esCCO ) without invasive calibration and to compare the results with those using transthoracic Doppler echocardiography (DCO TTE ). Methods Fifty-four consecutive patients were enrolled in this study following elective cardiac surgery. The CO esCCO and CO TTE were collected during four consecutive steps: 1) at baseline, 2) during passive leg raising (PLR), 3) at return to baseline, and 4) after a fluid challenge. The relationship between DCO esCCO and DCO TTE induced by PLR and a fluid challenge was assessed and a polar plot analysis was performed. Relationship, Bland-Altman analysis, and percentage error for absolute values of CO esCCO and CO TTE were also performed. Results Twenty-four patients were excluded from the analysis. No correlation was found between DCO esCCO and DCO TTE during PLR (r = 0.07; P = 0.732; n = 30) and after a fluid challenge (r = 0.24; P = 0.394; n = 14). The polar plot analysis showed that 21 data points (87%) of significant changes in CO were above the 30°radial sector lines and confirmed that esCCO was unable to track changes in CO. A weak positive relationship was found between absolute values of CO esCCO and CO TTE (r = 0.28; P = 0.004). Bias, precision, and limits of agreement were 0.25 LÁmin -1 , 2.4 LÁmin -1 , and -4.4 to 4.9 LÁmin -1 , respectively. The percentage error was 80%. Conclusions Estimated continuous cardiac output without external calibration seems unable to assess rapid changes in CO following cardiac surgery and was not interchangeable with transthoracic Doppler echocardiography.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

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“…Critchley et al used an exclusion zone around small differences between measurements to limit this effect on the measurement of concordance. 14 …”

Section: Discussionmentioning

confidence: 99%

“…By convention, a correlation for a stand-alone device should be [ 90%, but since the POC is being used as an adjunct to the laboratory measure, it certainly retains clinical utility in the management of the liver transplantation surgery. 14 Nevertheless, its cautious use, particularly in the neohepatic phase, is an important consideration.…”

Section: Discussionmentioning

confidence: 99%

Reliability of a point-of-care device for international normalized ratio testing during the three surgical phases of orthotopic liver transplantation: a retrospective observational study

Mace

Lightfoot

Cordero-Rochet

et al. 2015

Can J Anesth/J Can Anesth

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Purpose To investigate the reliability of a point-of-care device, the HEMOCHRON Ò Jr. Signature, for measuring the international normalized ratio (INR) during the three surgical phases of liver transplantation. Methods A retrospective review was performed on patients undergoing liver transplantation during July to December 2013. Thirty-one patients who had simultaneous laboratory and point-of-care INR readings from each phase of liver transplant surgery (paleohepatic, anhepatic, and neohepatic) were eligible for inclusion. Bland-Altman analysis, Spearman's rank correlation, and four quadrant plots were used to compare INR results from the point-ofcare device (pocINR) with those from the laboratory (labINR). Results Based on the Bland-Altman analysis, mean biases (95% prediction interval) were 0.10 (0.03 to 0.17), 0.19 (0.12 to 0.27), and 0.21 (0.01 to 0.43) for the paleohepatic, anhepatic, and neohepatic phases, respectively. The pocINR device showed a systematic underestimation of the labINR. The Spearman's rank correlation coefficients (95% confidence interval [CI]) were: Q = 0.90 (95% CI 0.80 to 0.95); Q = 0.92 (95% CI 0.71 to 0.93); and Q = 0.71 (95% CI 0.46 to 0.85), respectively. Direction-of-change analysis between the paleohepatic to anhepatic and the anhepatic to neohepatic phases showed strong concordance of 84% and, also considering the small bias between the measurements, supports the use of the pocINR device in the clinical management of liver transplant surgery. Conclusion Point-of-care INR was accurate prior to hepatic reperfusion, but reliability decreased in the neohepatic phase. RésuméObjectif É tudier la fiabilité d'un dispositif au chevet, l'HEMOCHRON Ò Jr. Signature, pour la mesure du rapport international normalisé (RIN) pendant les trois phases chirurgicales d'une transplantation hépatique. Méthodes : Une analyse rétrospective a été menée sur des patients ayant subi une transplantation hépatique entre juillet et décembre 2013. Trente et un patients ayant des

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“…Claiming the new methods to have at least the same individual error as the TEE would result in an acceptable PE of ±10.2 %. Applying this cut-off to the data, none of the three less-invasive techniques would be valid in comparison with the reference method TEE in terms of normal prosthetic valve function, as well as in AS and valvulopasty-induced AI.Petzoldt and colleagues also evaluated trending of the less-invasive methods in comparison to TEE using the polar plot analysis [4]. In this analysis, paired data of the changes displayed by the monitors are converted to polar coordinates where agreement is shown by the angle with the polar axis (0°or 180°, respectively) and the magnitude of the change in stroke volume by the distance from the origin.…”

mentioning

confidence: 99%

Assessment of agreement and trending between haemodynamic monitors is still challenging

et al. 2014

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Dear Editor, We read with interest the article by Petzoldt et al. [1] who evaluated agreement and trending between three less invasive methods and transoesophageal echocardiography (TEE) in terms of stroke volume in patients with aortic valve dysfunctions. The authors found a coefficient of error (CE) of 3.6 ± 3.0 % for their reference method TEE, resulting in a precision of 7.2 % (2 9 CE). BlandAltman analysis revealed percentage errors (PE) for the transpulmonary thermodilution (TPTD) of 14.9 % in the TPTD as a valid method in severe PE's of 26.3 and 26.2 % in aortic stenosis and insufficiency, respectively. The authors concluded that there was a tolerable agreement between TEE and TPTD as the PE fell in a range of ±30 % [2] and therefore stated that the TPTD is a valid method in severe aortic stenosis (AS) and valvulopasty-induced aortic insufficiency (AI). The benchmark at ±30 % (±28.3 % to be more precise) refers to the assumption that intermittent thermodilution (ITD) by the pulmonary artery catheter has a precision of ±20 % and means that if PE lies within a range of ±30 %, methods are interchangeable with ITD as they show a comparable individual error. In this study, TEE showed a superior precision (7.2 %) than ITD and, consequently, redetermining the range of an acceptable PE could be considered [3]. Claiming the new methods to have at least the same individual error as the TEE would result in an acceptable PE of ±10.2 %. Applying this cut-off to the data, none of the three less-invasive techniques would be valid in comparison with the reference method TEE in terms of normal prosthetic valve function, as well as in AS and valvulopasty-induced AI.Petzoldt and colleagues also evaluated trending of the less-invasive methods in comparison to TEE using the polar plot analysis [4]. In this analysis, paired data of the changes displayed by the monitors are converted to polar coordinates where agreement is shown by the angle with the polar axis (0°or 180°, respectively) and the magnitude of the change in stroke volume by the distance from the origin. To analyse and visualize good and acceptable trending, Petzoldt et al.[1] additionally drew horizontal lines at ±10 and ±20 % of the change of stroke volume within the polar plot and calculated the percentage of values lying within the horizontal 10 % limits. This analytical approach revealed a high percentage of values lying within these predefined limits for all three less-invasive methods (72-100 %) in comparison with TEE. This result led the authors to conclude that all of the test methods showed an acceptable ability to detect changes in stroke volume in patients with aortic valve dysfunction. Most strikingly, their polar plot analysis between TEE and TPTD in AS on the one side and between TEE and uncalibrated pulse contour analysis in AI on the other side showed the same percentage rate of 89 %, suggesting a comparable acceptable trending ability of both methods. As the polar plot analysis is based on the conversion of the haemodynamic change to a radial vect...

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A Critical Review of the Ability of Continuous Cardiac Output Monitors to Measure Trends in Cardiac Output

Cited by 453 publications

References 69 publications

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Reliability of a point-of-care device for international normalized ratio testing during the three surgical phases of orthotopic liver transplantation: a retrospective observational study

Assessment of agreement and trending between haemodynamic monitors is still challenging

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