Agreement between continuous cardiac output measured by the fourth-generation FloTrac/Vigileo system and a pulmonary artery catheter in adult liver transplantation

Abstract

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.

Comparison of invasive and non-invasive measurements of cardiac index and systemic vascular resistance in living-donor liver transplantation: a prospective, observational study

“…Here, ClearSight™ did not exhibit clinically acceptable interchangeability with PAC in terms of CO and SVR. Similarly, previous studies have also reported poor interchangeability in the CI and SVR between PAC and other less-invasive arterial pulse wave analyses during liver transplantation [ 14 , 15 , 37 ]. Patients with cirrhosis undergoing liver transplantation possess unique characteristics, such as hyperdynamic circulation and low SVR, which potentially increase the inaccuracy of arterial pulse wave analysis [ 15 , 38 , 39 ].…”

“…Similarly, previous studies have also reported poor interchangeability in the CI and SVR between PAC and other less-invasive arterial pulse wave analyses during liver transplantation [ 14 , 15 , 37 ]. Patients with cirrhosis undergoing liver transplantation possess unique characteristics, such as hyperdynamic circulation and low SVR, which potentially increase the inaccuracy of arterial pulse wave analysis [ 15 , 38 , 39 ]. Additionally, rapid changes in hemodynamic status during liver transplantation occur due to massive bleeding, manipulation of the IVC, inflammatory mediators after reperfusion of the graft, and the common use of vasoactive drugs that affect vascular compliance, thus negatively affecting the accuracy of arterial pulse wave analysis, including ClearSight™ [ 1 , 3 , 22 ].…”

“…Several non-invasive hemodynamic monitoring techniques have been studied in various perioperative settings [ 9 , 10 ]. In liver transplantation, several comparative studies have compared non-invasive cardiac output (CO) monitoring with thermodilution measurement via a PAC; however, these studies failed to yield satisfactory accuracy [ 11 – 15 ]. ClearSight™ (Edwards Lifesciences, Irvine, CA, USA) is a continuous, non-invasive finger-cuff arterial pressure monitoring device that uses photoplethysmographic technology [ 16 ] and enables the continuous measurement of CO through arterial pulse waveform analysis [ 9 , 10 , 16 ].…”

Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

“…Uncalibrated or internally calibrated pulse wave analysis systems lose reliability when arterial tone changes significantly. This has been confirmed with the most recent models during coronary artery bypass [21–23], liver transplantation [24], or hyperthermic intraperitoneal chemotherapy [25], that is, situations in which the arterial tone varies to a large extent. This is also the case for finger-cuff systems, as recently reported in a meta-analysis [26].…”

Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review

“…While Flotrac™ is reasonably accurate in stable patients, in patients with low SVR, Flotrac™ does not provide accurate CO measurement when compared to invasive CO monitoring [67]. For instance, Murata et al showed that in end-stage liver failure patients, fourth-generation Flotrac™ and PAC readings had poor agreement with each other during liver transplantation [72]. Moreover, Lin et al found that fourth-generation Flotrac™ had a 61.82% and 51.80% error in estimating the CO before and after cardiopulmonary bypass, respectively.…”