Finger-cuff derived blood pressure & CO/CI measurement shows some accuracy when compared with invasive methods, however too much heterogeneity exists among studies for it to be reliably interchangeable.

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• Bernd Saugel, Phillip Hoppe, Julia Y Nicklas, Karim Kouz, Annmarie Körner, Julia C Hempel, Jaap J Vos, Gerhard Schön, and Scheeren Thomas W L TWL Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands..
• Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA. Electronic address: bernd.saugel@gmx.de.
• Br J Anaesth. 2020 Jul 1; 125 (1): 25-37.

BackgroundFinger cuff technologies allow continuous noninvasive arterial blood pressure (AP) and cardiac output/index (CO/CI) monitoring.MethodsWe performed a meta-analysis of studies comparing finger cuff-derived AP and CO/CI measurements with invasive measurements in surgical or critically ill patients. We calculated overall random effects model-derived pooled estimates of the mean of the differences and of the percentage error (PE; CO/CI studies) with 95%-confidence intervals (95%-CI), pooled 95%-limits of agreement (95%-LOA), Cochran's Q and I2 (for heterogeneity).ResultsThe pooled mean of the differences (95%-CI) was 4.2 (2.8 to 5.62) mm Hg with pooled 95%-LOA of -14.0 to 22.5 mm Hg for mean AP (Q=230.4 [P<0.001], I2=91%). For mean AP, the mean of the differences between finger cuff technologies and the reference method was ≤5±8 mm Hg in 9/27 data sets (33%). The pooled mean of the differences (95%-CI) was -0.13 (-0.43 to 0.18) L min-1 with pooled 95%-LOA of -2.56 to 2.23 L min-1 for CO (Q=66.7 [P<0.001], I2=90%) and 0.07 (0.01 to 0.13) L min-1 m-2 with pooled 95%-LOA of -1.20 to 1.15 L min-1 m-2 for CI (Q=5.8 [P=0.326], I2=0%). The overall random effects model-derived pooled estimate of the PE (95%-CI) was 43 (37 to 49)% (Q=48.6 [P<0.001], I2=63%). In 4/19 data sets (21%) the PE was ≤30%, and in 10/19 data sets (53%) it was ≤45%.ConclusionsStudy heterogeneity was high. Several studies showed interchangeability between AP and CO/CI measurements using finger cuff technologies and reference methods. However, the pooled results of this meta-analysis indicate that AP and CO/CI measurements using finger cuff technologies and reference methods are not interchangeable in surgical or critically ill patients.Clinical Trial NumberPROSPERO registration number: CRD42019119266.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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