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eComment: Non-invasive ultrasonic cardiac output monitoring in the surgical operating room

Hannover Medical School, Plastic, Hand and Reconstructive Surgery, Hannover, Germany

Cardiac output by arterial pulse contour: reliability under hemodynamic derangements

I read with great interest the recent experimental report by Dr. Romagnoli and co-workers evaluating a pressure-recording analytical method (PRAM, Most-Care) as an uncalibrated hemodynamic monitor in various hemodynamic states in anaesthetized swine [1]. In contrast to the PiCCO, the LiDCO or the Flo Trac (Vigileo) systems, which are to be calibrated, the Most-Care system is the only invasive pulse contour system that is thought not to require external calibration or preloaded data. However, both calibrated and non-calibrated pulse contour analysis do require an arterial line, thus it is invasive to a certain degree. Therefore, the claim to be non-invasive using pulse contour analysis is not valid.

The authors stated: ‘It is worth noting that measurement of CO is particularly useful for clinicians when changes in arterial tone occur (i.e. septic states, post CPB-SIRS-like states, vasoconstrictive therapies for arterial pressure maintenance, etc.).’ I would disagree with this statement, since hemodynamic information is important in various states. In the operating theatre, optimizing fluid resuscitation has been proved to improve clinical outcome. As such, complete non-invasive ultrasonic cardiac output monitoring (USCOM) has been found accurate during living transplantation [2].

Notably, as far as invasiveness is concerned, completely non-invasive external ultrasonic cardiac output monitoring has been tested clinically in various patient groups. USCOM compared with pulmonary artery catheters was found acceptable and capable in comparing different shock types in ICU patients [3]. In cardiac surgery patients, USCOM could determine non-invasive beat-to-beat cardiac output in postcardiac surgery patients without the possible complications associated with invasive right heart catheterization [4]. The USCOM cardiac output and stroke volume showed a very good agreement with invasive Swan-Ganz measures and correlated with central venous saturation percentage. Recently, USCOM has been used in cardiac output monitoring even in an orthotopic total artificial heart clinically (CardioWest) [5].

	References

Top References

 

1. Romagnoli S, Romano SM, Bevilacqua S, Ciappi F, Lazzeri C, Peris A, Dini D, Gelsomino S. Cardiac output by arterial pulse contour: reliability under hemodynamic derangements. Interact CardioVasc Thorac Surg 2009;8:642–646.[Abstract/Free Full Text]
2. Su BC, Yu HP, Yang MW, Lin CC, Kao MC, Chang CH, Lee WC. Reliability of a new ultrasonic cardiac output monitor in recipients of living donorliver transplantation. Liver Transplant 2008;14:1029–1037.[CrossRef][Medline]
3. van Lelyveld-Haas LE, van Zanten AR, Borm GF, Tjan DH. Clinical validation of the non-invasive cardiac output monitor USCOM-1A incritically ill patients. Eur J Anaesthesiol 2008;25:917–924.[CrossRef][Medline]
4. Knobloch K, Lichtenberg A, Winterhalter M, Rossner D, Pichlmaier M, Phillips R. Non-invasive cardiac output determination by two-dimensional independent Doppler during and after cardiac surgery. Ann Thorac Surg 2005;80:1479–1483.[Abstract/Free Full Text]
5. Phillips R, Lichtenthal P, Sloniger J, Burstow D, West M, Copeland J. Noninvasive cardiac output measurement in heart failure subjects oncirculatory support. Anesth Analg 2009;108:881–886.[Abstract/Free Full Text]

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				S. Romagnoli and S. M. Romano Estimation of Hemodynamic Parameters by Arterial Waveform: Available Technologies Anesth. Analg., January 1, 2010; 110(1): 257 - 258. [Full Text] [PDF]

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