Performance of a new pulse contour method for continuous cardiac output monitoring: Validation in critically ill patients

Abstract

Background. A new calibrated pulse wave analysis method (VolumeView TM/EV1000TM, Edwards Lifesciences, Irvine, CA, USA) has been developed to continuously monitor cardiac output (CO). The aim of this study was to compare the performance of the VolumeView method, and of the PiCCO2TM pulse contour method (Pulsion Medical Systems, Munich, Germany), with reference transpulmonary thermodilution (TPTD) CO measurements. Methods. Thiswas a prospective,multicentre observational study performed in the surgical and interdisciplinary intensive care units of four tertiary hospitals. Seventy-two critically ill patients were monitored with a central venous catheter, and a thermistor-tipped femoral arterial VolumeViewTM catheter connected to the EV1000TM monitor. After initial calibration by TPTD CO was continuously assessed using the VolumeView-CCO software (CCOVolumeView) during a 72 h period. TPTD was performed in order to obtain reference CO values (COREF). TPTD and arterial wave signals were transmitted to a PiCCO2TM monitor in order to obtain CCOPiCCO values. CCOVolumeView and CCOPiCCO were recorded over a 5 min interval before assessment of COTPTD. Bland-Altman analysis, %errors, and concordance (trend analysis) were calculated. Results. A total of 338 matched sets of data were available for comparison. Bias for CCOVolumeView-COREF was -0.07 litre min-1 and for CCOPiCCO-COREF +0.03 litre min21. Corresponding limits of agreement were 2.00 and 2.48 litre min-1 (P<0.01),%errors 29 and 37%, respectively. Trending capabilities were comparable for both techniques. Conclusions. The performance of the new VolumeViewTM-CCO method is as reliable as the PiCCO 2TM-CCO pulse wave analysis in critically ill patients. However, an improved precision was observed with the VolumeViewTM technique. Clinicaltrials.gov identifier. NCT01405040. © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.