Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 4 ( April, 2022 ) > List of Articles

Original Article

Accuracy of Estimated Continuous Cardiac Output Monitoring (esCCO) Using Pulse Wave Transit Time (PWTT) Compared to Arterial Pressure-based CO (APCO) Measurement during Major Surgeries

Malini Joshi, Resham Rathod, Shilpushp J Bhosale

Keywords : Arterial pressure-based cardiac output, Bias, Estimated continuous cardiac output, Limits of agreement, Percentage error, Precision, Pulse wave transit time

Citation Information : Joshi M, Rathod R, Bhosale SJ. Accuracy of Estimated Continuous Cardiac Output Monitoring (esCCO) Using Pulse Wave Transit Time (PWTT) Compared to Arterial Pressure-based CO (APCO) Measurement during Major Surgeries. Indian J Crit Care Med 2022; 26 (4):498-502.

DOI: 10.5005/jp-journals-10071-24158

License: CC BY-NC 4.0

Published Online: 13-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Pulse wave transit time is a novel method of estimating continuous cardiac output (esCCO). Since there are not many studies evaluating esCCO, we compared it with arterial pressure based cardiac output (APCO) method (FloTrac). Methods: In this prospective single-center observational study, we included 50 adult patients planned to undergo supramajor oncosurgeries, where major blood loss and extensive fluid shifts were expected. Cardiac output (CO) measurements were obtained by both methods at five distinct time points, giving us 250 paired readings of stroke volume index (SVI) and cardiac index (CI). We analyzed these readings using Pearson's correlation coefficient and Bland–Altman plots, along with other appropriate statistical tests. Results: There was significant correlation between CI and SVI measured by the esCCO and APCO. Bland–Altman plot analysis for CI showed a bias of −0.44 L/minute/m2, precision of 0.74, and the limits of agreement of −1.89 and +1.01, while the percentage error was 46.29%. Bland–Altman analysis for SVI showed a bias −5.07 mL with a precision of 9.36, and the limits of agreement to be −23.4 to +13.28. The percentage error was 46.56%. Conclusion: This study demonstrated that esCCO tended to underestimate the CI to a large degree, particularly while estimating the cardiac output in the lower range. We found that the limits of agreement between two methods were wide, which are not likely to be clinically acceptable. Further studies with larger number of data points, obtained in a similar subset of patients, for cardiac output measurement in the perioperative period will certainly help determine if pulse wave transit time (PWTT) is here to stay (CTRI No.: CTRI/2019/08/020543).


HTML PDF Share
  1. Myles P, Bellomo R, Corcoran T, Forbes A, Wallace S, Peyton P, et al. Australian and New Zealand College of Anaesthetists Clinical Trials Network, and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial. BMJ Open 2017;7(3):e015358. DOI: 10.1136/bmjopen-2016-015358.
  2. Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 2010;14(3):R118. DOI: 10.1186/cc9070.
  3. Cecconi M, Monti G, Hamilton MA, Puntis M, Dawson D, Tuccillo ML, et al. Efficacy of functional hemodynamic parameters in predicting fluid responsiveness with pulse power analysis in surgical patients. Minerva Anestesiol 2012;78(5):527–533. PMID: 22534733.
  4. Mayer J, Boldt J, Mengistu AM, Röhm KD, Suttner S. Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Crit Care 2010;14(1):R18. DOI: 10.1186/cc8875.
  5. Saugel B, Kouz K, Scheeren TWL. The ‘5 Ts’ of perioperative goal-directed haemodynamic therapy. Br J Anaesth 2019;123(2):103–107. DOI: 10.1016/j.bja.2019.04.048.
  6. Salzwedel C, Puig J, Carstens A, Bein B, Molnar Z, Kiss K, et al. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care 2013;17(5):R191. DOI: 10.1186/cc12885.
  7. Yamada T, Tsutsui M, Sugo Y, Sato T, Akazawa T, Sato N, et al. Multicenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output. Anesth Analg 2012;115(1):82–87. DOI: 10.1213/ANE.0b013e31824e2b6c.
  8. Terada T, Oiwa A, Maemura Y, Robert S, Kessoku S, Ochiai R. Comparison of the ability of two continuous cardiac output monitors to measure trends in cardiac output: estimated continuous cardiac output measured by modified pulse wave transit time and an arterial pulse contour-based cardiac output device. J Clin Monit Comput 2016;30(5):621–627. DOI: 10.1007/s10877-015-9772-x.
  9. Tsutsui M, Araki Y, Masui K, Kazama T, Sugo Y, Archer TL, et al. Pulse wave transit time measurements of cardiac output in patients undergoing partial hepatectomy: a comparison of the esCCO system with thermodilution. Anesth Analg 2013;117(6):1307–1312. DOI: 10.1213/ANE.0b013e3182a44c87.
  10. Magliocca A, Rezoagli E, Anderson TA, Burns SM, Ichinose F, Chitilian HV. Cardiac output measurements based on the pulse wave transit time and thoracic impedance exhibit limited agreement with thermodilution method during orthotopic liver transplantation. Anesth Analg 2018;126(1):85–92. DOI: 10.1213/ANE.0000000000002171.
  11. Terada T, Kessoku S, Suzuki A, Kurosawa A, Nakagomi S, Oiwa A, et al. Comparison of the pulse wave transit time method and an arterial pressure-based cardiac output system for measuring cardiac output trends during laparotomy without postural change. Asian J Anesthesiol 2019;57(3):85–92. DOI: 10.6859/aja.201909_57(3).0003.
  12. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999;15(2):85–91. DOI: 10.1023/a: 1009982611386.
  13. Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies–with specific reference to the measurement of cardiac output. Crit Care 2009;13(1):201. DOI: 10.1186/cc7129.
  14. Wacharasint P, Kunakorn P, Pankongsap P, Preechanukul R. Clinical validation of pulse contour and pulse wave transit time-based continuous cardiac output analyses in Thai patients undergoing cardiac surgery. J Med Assoc Thai 2014;97 Suppl 1:S55–S60. PMID: 24855843.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.