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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Dec 13

DOI: 10.23736/S0375-9393.17.12051-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Agreement between ccNexfin CO-trek cardiac output and intermittent cold-bolus pulmonary thermodilution in a prospective multi-centre study

Nicolaas H. SPERNA WEILAND 1 , Jim W. de WEVER 2, Yoni van DUIVENVOORDE 2, Christa BOER 2, Ludmil MITREV 3, Muhammad MUNTAZAR 3, Kinjal PATEL 3, Markus W. HOLLMANN 1, Benedikt PRECKEL 1

1 Department of Anaesthesiology, Academic Medical Centre AMC Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; 2 Department of Anaesthesiology, VU University Medical Centre, Amsterdam, The Netherlands; 3 Department of Anaesthesiology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA


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BACKGROUND: The ccNexfin system uses the CO-trek algorithm to analyse a non-invasively obtained arterial pressure waveform and calculate cardiac output (NEXCO). It remains matter of debate whether NEXCO can replace invasive, pulmonary artery catheter derived, cold-bolus pulmonary thermodilution cardiac output measurement (PACCO). This study aimed at testing NEXCO-PACCO agreement in a large sample size, multi-centre study. We hypothesized that agreement between NEXCO and PACCO would be demonstrated by a mean accuracy (bias) < 0.6 l·min-1 with a percentage error < 30%.
METHODS: Patients undergoing cardiac surgery in three academic hospitals clinically requiring pulmonary artery catheterisation were included. Exclusion criteria were aortic, pulmonary and tricuspid (valve) abnormalities, non-sinus rhythm and insufficient perfusion of the digits such as in Raynaud’s disease. After induction of anaesthesia, cardiac output was measured with four cold bolus thermodilution measurements and four averaged thirty second ccNexfin measurements randomised through the respiratory cycle to obtain one measurement pair. Mean accuracy and precision of ccNexfin were expressed as bias (mean of all NEXCO-PACCO differences) and limits of agreement (LOA; 1.96 · SD of bias). Percentage error was calculated as [LOA/ (NEXCO-PACCO average)].
RESULTS: Fifty-five patients were enrolled in the study, 51 completed the protocol. Median PACCO was 3.7 (IQR: 3.2 to 4.6) l·min-1 and median NEXCO was 3.8 (IQR: 3.1 to 4.7) l·min-1. NEXCO-PACCO bias was 0.1 (LOA: -1.4 to +1.6) l·min-1 with a 37% percentage error.
CONCLUSION: In this study, cardiac output measurement with ccNexfin failed to meet the predefined criteria for agreement with cold-bolus pulmonary artery thermodilution.


KEY WORDS: Cardiac output - Catheterization, swan-ganz - Pulse wave analysis - Thermodilution - Validation studies as topic

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Publication History

Article first published online: December 13, 2017
Manuscript accepted: November 30, 2017
Manuscript revised: November 21, 2017
Manuscript received: March 8, 2017

Per citare questo articolo

Sperna Weiland NH, Wever JW, Duivenvoorde YV, Boer C, Mitrev L, Muntazar M et al. Agreement between ccNexfin CO-trek cardiac output and intermittent cold-bolus pulmonary thermodilution in a prospective multi-centre study. Minerva Anestesiol 2017 Dec 13. DOI: 10.23736/S0375-9393.17.12051-1

Corresponding author e-mail

N.H.SpernaWeiland@amc.uva.nl