Cardiac output and stroke volume variation measured by the pulse wave transit time method: a comparison with an arterial pressure-based cardiac output system

Abstract

Hemodynamic monitoring is mandatory for perioperative management of cardiac surgery. Recently, the estimated continuous cardiac output (esCCO) system, which can monitor cardiac output (CO) non-invasively based on pulse wave transit time, has been developed. Patients who underwent cardiovascular surgeries with hemodynamics monitoring using arterial pressure-based CO (APCO) were eligible for this study. Hemodynamic monitoring using esCCO and APCO was initiated immediately after intensive care unit admission. CO values measured using esCCO and APCO were collected every 6 h, and stroke volume variation (SVV) data were obtained every hour while patients were mechanically ventilated. Correlation and Bland-Altman analyses were used to compare APCO and esCCO. Welch's analysis of variance, and four-quadrant plot and polar plot analyses were performed to evaluate the effect of time course, and the trending ability. A p-value < 0.05 was considered statistically significant. Twenty-one patients were included in this study, and 143 and 146 datasets for CO and SVV measurement were analyzed. Regarding CO, the correlation analysis showed that APCO and esCCO were significantly correlated (r = 0.62), and the bias ± precision and percentage error were 0.14 ± 1.94 (L/min) and 69%, respectively. The correlation coefficient, bias ± precision, and percentage error for SVV evaluation were 0.4, - 3.79 ± 5.08, and 99%, respectively. The time course had no effects on the biases between CO and SVV. Concordance rates were 80.3 and 75.7% respectively. While CO measurement with esCCO can be a reliable monitor after cardiovascular surgeries, SVV measurement with esCCO may require further improvement.

Journal of Clinical Monitoring and Computing end of year summary 2019: hemodynamic monitoring and management

“…It provides estimated continuous cardiac output (esCCO) based on pulse wave transit time technology measured using the electrocardiogram (ECG) and peripheral pulse oximeter. Suzuki et al [9] compared both cardiac output and stroke volume variation (SVV) against FloTrac readings in 21 post cardiovascular surgery patients, mainly aortic aneurysm repairs. The data did not support the clinical use of esCCO as percentage errors were 69% and 99% for cardiac output and SVV, respectively.…”

Pulse wave transit time during exercise testing reflects the severity of heart disease in cardiac patients

“…Very recently, Sano et al (16) found that the change in PWTT predicts fluid responsiveness in mechanically ventilated anesthetized dogs given a fluid challenge. Suzuki et al (17) also reported the usefulness of estimating cardiac output by PWTT at resting condition in patients after cardiovascular surgeries. Based on the findings of the recent reports and our study, monitoring of PWTT during exercise testing would provide noninvasive, and continuous estimate of cardiac output during exercise.…”

The Effect of Surgical Patient Positions on Plet Variability Index, Perfusion Index and Noninvasive Continuous Cardiac Output Measurement Method in Voluntary Breathing Volunteers

“…(17). Güncel ve az sayıda literatür bilgilerinde intraoperatif hemodinamik monitörizasyon açısından diğer invazif yöntemlere göre zayıf bir izlem aracı olarak belirtilse de postoperatif izlem açısından daha uyumlu olduğu tespit edilmiştir (18,19…”