Abstract 15559: Comparison of Cardiac Output Assessment With Two Different Minimally-invasive Pulse Contour Analysis-monitoring Devices and Echocardiography During Mild Therapeutic Hypothermia and Normothermia
Background: Post-cardiac arrest myocardial dysfunction and hemodynamic instability characterize survivors of out-of-hospital cardiac arrest (OHCA). There is a need for optimal hemodynamic monitoring including cardiac output, during both mild therapeutic hypothermia (MTH) and the following normothermic period. Clinical practice using less invasive techniques based on arterial waveform analyses have gained increased interest.
Hypothesis: Minimally invasive hemodynamic monitoring devices with thermodilution calibration provide more precise cardiac output (CO) measurements during MTH than measurements without calibration.
Methods: Comatose OHCA survivors receiving MTH underwent hemodynamic monitoring with arterial pulse contour analyses with transpulmonary thermodilution calibration (PiCCO2 plus system, Pulsion Medical systems, Munich, Germany) and without calibration (FloTrac pressure sensor, Vigileo monitor, Edwards Lifescience, Irvine, USA) every eight hours during 24 hours of MTH and the following 24 hours of normothermia. CO was also measured by transthoracic echocardiography (TTE) during stable hypothermia and normothermia.
Results: Twenty-six patients were included. Mean age was 64 years, 73% males, 77% had initial shockable rhythm. Median CO (l/min, 95% CI) measurements for CO-PiCCO2, CO-Vigileo, and CO-TTE were 3.7 (3.2-4.6), 4.0 (3.3-4.8), 3.6 (3.2-4.2) during hypothermia, and 6.5 (5.6-9.1), 5.6 (4.5-7.5), 5.8 (4.7-7.5)) during normothermia, respectively. Bias (1SD) between CO-PiCCO2 and CO-TTE was 0.05 (0.97) l/min during hypothermia and 1.16 (1.11) l/min during normothermia, respectively. Bias between CO-Vigileo and CO-TTE were 0.40 (1.56) during hypothermia and 0.11 (1.51) l/min during normothermia. Bias between CO-Vigileo and CO- PiCCO2 were 0.34 (1.16) during hypothermia and 1.06 (1.75) l/min during normothermia.
Conclusion: Our results revealed low bias and reasonable precision between CO measurements with PiCCO2, Vigileo and TEE during hypothermia. Arterial pulse contour analyses may be used to monitor cardiac output during MTH. Precision was not improved by transpulmonary thermodilution calibration.
Author Disclosures: H. Staer-Jensen: None. K. Sunde: None. E.R. Nakstad: None. J. Eritsland: None. G.Ø. Andersen: None.
- © 2016 by American Heart Association, Inc.