• Gerardo Tusman, Cecilia M Acosta, Mats Wallin, Magnus Hallbäck, Mariano Esperatti, Georgina Peralta, María Eugenia Gonzalez, and Fernando Suarez-Sipmann.
• Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 2900-2907.

ObjectivesTo test the clinical performance of a novel continuous noninvasive cardiac output (CO) monitoring based on expired carbon dioxide kinetics in cardiac surgery patients.DesignA prospective feasibility pragmatic clinical study.SettingA single-center, large community hospital.ParticipantsThirty-two patients undergoing cardiac surgery were studied during the intraoperative (before cardiopulmonary bypass) and postoperative (in the intensive care unit before extubation) periods.InterventionsCO was measured simultaneously by the continuous capnodynamic method and by transpulmonary thermodilution during changes in the patient's hemodynamic and/or respiratory conditions.Measurements And Main ResultsThe current recommended comparative statistics for CO measurement methods were analyzed, including bias, precision, and percentage error obtained from Bland-Altman analysis, and concordance between methods obtained from the four-quadrant plot analysis to evaluate the trending ability. Bias ± limits of agreement and percentage error were -0.6 (-1.9 to +0.8; 95% CI of 3.73-5.25) L/min and 31% (n = 147 measurements) for the intraoperative period, -0.8 (-2.4 to +0.9; 95% CI of 3.03-5.21) L/min and 41% (n = 66) for the postoperative period, and -0.6 (-2.1 to +0.8; 95% CI of 3.74-5.00) L/min and 34% (n = 213) for the pooled data. The trending analysis obtained a concordance of 82% (n = 65) for the intraoperative and 71% (n = 24) for the early postoperative periods. Aggregation of both data sets gave a concordance of 79% (n = 89).ConclusionsThe continuous capnodynamic method was reliable and in good agreement with the reference method, and had an accuracy and trending ability good enough to make it a possible future alternative for hemodynamic monitoring in the studied population of elective adult cardiac surgery patients.Copyright © 2022 Elsevier Inc. All rights reserved.

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