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Cardiac output by arterial pulse contour: reliability under hemodynamic derangements

^a Department of Heart and Vessels, Experimental Surgery Unit, Careggi Hospital, Viale Morgagni 85, 50134 Florence, Italy
^b Department of Cardiac and Vascular Anesthesia and Post-Surgical Intensive Care Unit, Careggi Hospital, Viale Morgagni 85-50134 Florence, Italy
^c Department of Critical Care Medicine and Surgery, University of Florence, Careggi Hospital, Florence, Italy
^d Department of Intensive Care Medicine, Careggi Hospital, Florence, Italy

*Corresponding author. Tel.: +39-055-794 7557; fax: +39-055-794 7506.

E-mail address: stefano.romagnoli{at}fastdigitel.com (S. Romagnoli).

Pulse contour methods (PCM) for the measurements of cardiac output (CO) are gaining popularity in intensive care settings but their reliability during hemodynamic instability has been questioned. Pressure-recording-analytical-method (PRAM) is a newly developed uncalibrated hemodynamic monitor and its capability in measuring CO during hemodynamic instability is still under investigation. Dobutamine (2.5 and 5 µg/kg/min), vasoconstriction (arginine-vasopressin 4, 8 and 16 IU/h), hemorrhage (–10%, –20%, –35%, and –50% of the theoretical volemia), and volume resuscitation were induced in eight swine. CO by means of thermodilution (CO_ThD), transesophageal echocardiography (CO_TEE) and PRAM (CO_PRAM) were contemporarily registered. R², bias, and percentage error were used to compare the methods. Comparison between CO_PRAM and CO_ThD resulted in: r²=0.87; bias=–0.006 l/min; precision=±0.87 l/min; percentage error=22.8%. Comparison between CO_PRAM and CO_TEE resulted in: r²=0.85; bias=–0.007 l/min; precision=±0.86 l/min; percentage error=22%. Sub-group analysis revealed disagreement between methods only during the last two steps of hemorrhage: CO_PRAM vs. CO_ThD: r²=0.67, bias=–0.37 l/min, precision=±1.04 l/min, limits of agreement=–1.39+0.66 l/min, and percentage error=45%; CO_PRAM vs. CO_TEE: r²=0.38, bias=0.4 l/min, precision=±1.42 l/min, limits of agreement=–0.99+1.79 l/min, and percentage error=62%. PRAM resulted to be accurate in measuring CO during hemodynamic stability, tachycardia, and vasoconstriction. When volemia was reduced by >35%, disagreement between methods was observed.

Key Words: Most-Care^TM; Pressure-recording-analytical-method (PRAM); Cardiac output; Arterial pulse contour

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