• Martin Geisen, Michael T Ganter, Sonja Hartnack, Omer Dzemali, Christoph K Hofer, and Andreas Zollinger.
• Institute of Anaesthesiology and Intensive Care Medicine, Triemli Hospital Zurich, Zurich, Switzerland.
• J. Cardiothorac. Vasc. Anesth. 2018 Apr 1; 32 (2): 715-722.

ObjectiveThe aim of this study was to analyze the accuracy, precision, and trending ability of the following 4 pulse wave analysis devices to measure continuous cardiac output: PiCCO2 ([PCCO]; Pulsion Medical System, Munich, Germany); LiDCORapid ([LCCO]; LiDCO Ltd, London, UK); FloTrac/Vigileo ([FCCO]; Edwards Lifesciences, Irvine, CA); and Nexfin ([NCCO]; BMEYE, Amsterdam, The Netherlands).DesignProspective, observational clinical study.SettingIntensive care unit of a single-center, teaching hospital.ParticipantsThe study comprised 22 adult patients after elective coronary artery bypass surgery.InterventionsThree measurement cycles were performed in all patient durings their immediate postoperative intensive care stay before and after fluid loading. Hemodynamic measurements were performed 5 minutes before and immediately after the administration of 500 mL colloidal fluid over 20 minutes.Measurements And Main ResultsPCCO, LCCO, FCCO, and NCCO were assessed and compared with cardiac output derived from intermittent transpulmonary thermodilution (ICO). One hundred thirty-two matched sets of data were available for analysis. Bland-Altman analysis using linear mixed effects models with random effects for patient and trial revealed a mean bias ±2 standard deviation (%error) of -0.86 ± 1.41 L/min (34.9%) for PCCO-ICO, -0.26 ± 2.81 L/min (46.3%) for LCCO-ICO, -0.28 ± 2.39 L/min (43.7%) for FCCO-ICO, and -0.93 ± 2.25 L/min (34.6%) for NCCO-ICO. Bland-Altman plots without adjustment for repeated measurements and replicates yielded considerably larger limits of agreement. Trend analysis for all techniques did not meet criteria for acceptable performance.ConclusionsAll 4 tested devices using pulse wave analysis for measuring cardiac output failed to meet current criteria for meaningful and adequate accuracy, precision, and trending ability in cardiac output monitoring.Copyright © 2017. Published by Elsevier Inc.

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