Study of the accuracy of a radial arterial pressure waveform cardiac output measurement device after cardiac surgery

Pilar Ordoñez-Rufat; Nuria Mancho-Fora; Cristian Tebe-Cordomi; Victoria Polit-Martinez; Ricardo Abellan-Lencina; Joaquin Fernandez-Alvarez; Juan Carlos Lopez-Delgado

doi:10.1186/s13019-023-02128-1

Study of the accuracy of a radial arterial pressure waveform cardiac output measurement device after cardiac surgery

J Cardiothorac Surg. 2023 Jan 17;18(1):32. doi: 10.1186/s13019-023-02128-1.

Authors

Pilar Ordoñez-Rufat¹, Nuria Mancho-Fora², Cristian Tebe-Cordomi², Victoria Polit-Martinez³, Ricardo Abellan-Lencina³, Joaquin Fernandez-Alvarez³, Juan Carlos Lopez-Delgado^{3

4}

Affiliations

¹ Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain. pordonezr@gmail.com.
² Biostatistics Department, Universitat de Barcelona, Campus Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907, Hospitalet de Llobregat, Barcelona, Spain.
³ Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain.
⁴ IDIBELL (Biomedical Research Institute of Bellvitge), Avda. de La Granvia de L'Hospitalet, 199, 08908, Hospitalet de Llobregat, Barcelona, Spain.

Abstract

Background: Less invasive monitoring, such as radial arterial pulse contour analysis (ProAQT® sensor), represents an alternative when hemodynamic monitoring is necessary to guide postoperative management and invasive monitoring is not technically feasible. The aim of the study is to evaluate the accuracy of the ProAQT® sensor cardiac output measurements in comparison with Pulmonary Artery Catheter (PAC) during the postoperative course of patients who underwent cardiac surgery with cardiopulmonary bypass.

Case presentation: Prospective observational study in a Surgical Intensive Care Unit of a tertiary university hospital. Ten patients with a mean age of 73.5 years were included. The main comorbidities were hypertension, diabetes, dyslipidemia and the preoperative left ejection fraction was 43.8 ± 14.5%. Regarding the type of surgery, six patients underwent valve surgery, two underwent coronary artery bypass grafting and two underwent aortic surgery. The cardiac index measured simultaneously by the ProAQT® sensor was compared with the PAC. The parameters were evaluated at predefined time points during the early postoperative courses (6 h, 12 h, 24 h, 48 h and 72 h). The degree of agreement with the cardiac index between the PAC and the ProAQT® sensor along the time points was measured using the concordance correlation coefficient, Bland-Altman analysis, and four-quadrant plot. Sixty-three pairs of measurements were analyzed. We showed that measurements of cardiac index were slightly higher with PAC (β ̂ = - 0.146, p-value = 0.094). The concordance correlation coefficient for the additive model of cardiac index was 0.64 (95% Confidence Interval: 0.36, 0.82), indicating a high concordance between both sensors. Bland-Altmann analysis showed a mean bias of 0.45 L·min^-1·m^-2, limits of agreement from - 1.65 to 2.3 L·min^-1·m^-2, and percentage of error was 82.5%. Four-quadrant plot of changes in cardiac index showed a good concordance rate (75%), which increases after applying the exclusion zone (87%).

Conclusions: In patients undergoing cardiac surgery, the ProAQT® sensor may be useful to monitor cardiac index during the postoperative period, especially when more invasive monitoring is not possible.

Keywords: Arterial pulse contour analysis; Cardiac surgery; Hemodynamic monitoring; Pulmonary artery catheter.

Publication types

Observational Study
Case Reports

MeSH terms

Aged
Arterial Pressure*
Cardiac Output
Cardiac Surgical Procedures*
Coronary Artery Bypass
Humans
Monitoring, Intraoperative
Reproducibility of Results