• Johannes Menger, Bruno Mora, Keso Skhirtladze, Arabella Fischer, Hendrik Jan Ankersmit, and Martin Dworschak.
• Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine.
• J. Cardiothorac. Vasc. Anesth. 2016 Jun 1; 30 (3): 592-8.

ObjectiveTo evaluate the effect of intra-aortic counterpulsation on precision, accuracy, and concordance of continuous pulse contour cardiac output determined using LiDCOplus (LiDCO Group, London).DesignProspective trial.SettingUniversity hospital critical care unit.ParticipantsPatients with intra-aortic balloon pump support in the 1:1 mode after elective or urgent cardiac surgery.InterventionsLithium dilution calibrated pulse contour cardiac output was compared with pulmonary artery bolus thermodilution cardiac output during hemodynamically stable conditions in the course of standardized postoperative management.Measurements And Main ResultsFifty-one paired measurements demonstrated good correlation between the 2 methods (r = 0.88, p<0.001). Mean bias was -0.14±0.81 L/min, limits of agreement 1.48 to -1.77 L/min, and percentage error 28%. Concordance between the 2 techniques regarding directional changes>±10% cardiac output was 100% (p = 0.008). Trending ability was moderate when paired cardiac output changes were assessed using linear regression, 4-quadrant table, and polar plots. When changes <±10% of the reference cardiac output were excluded, 90% of the data pairs still lay within the 30° radial limits. Optimal timing of the balloon pump was indispensable for proper determination of pulse contour cardiac output.ConclusionsBecause of the LiDCOplus-specific algorithm in determining stroke volume from the arterial pulse waveform, which differs from other devices, accuracy and precision of continuous pulse contour cardiac output only are affected insignificantly by intra-aortic counterpulsation. The authors nevertheless caution that the device should be recalibrated after major hemodynamic alterations or otherwise inexplicable changes of the pulse contour cardiac output to improve trending.Copyright © 2016 Elsevier Inc. All rights reserved.

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