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A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients

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Abstract

The CNAP technology (CNSystems Medizintechnik AG, Graz, Austria) allows continuous noninvasive arterial pressure waveform recording based on the volume clamp method and estimation of cardiac output (CO) by pulse contour analysis. We compared CNAP-derived CO measurements (CNCO) with intermittent invasive CO measurements (pulmonary artery catheter; PAC-CO) in postoperative cardiothoracic surgery patients. In 51 intensive care unit patients after cardiothoracic surgery, we measured PAC-CO (criterion standard) and CNCO at three different time points. We conducted two separate comparative analyses: (1) CNCO auto-calibrated to biometric patient data (CNCObio) versus PAC-CO and (2) CNCO calibrated to the first simultaneously measured PAC-CO value (CNCOcal) versus PAC-CO. The agreement between the two methods was statistically assessed by Bland–Altman analysis and the percentage error. In a subgroup of patients, a passive leg raising maneuver was performed for clinical indications and we present the changes in PAC-CO and CNCO in four-quadrant plots (exclusion zone 0.5 L/min) in order to evaluate the trending ability of CNCO. The mean difference between CNCObio and PAC-CO was +0.5 L/min (standard deviation ± 1.3 L/min; 95% limits of agreement −1.9 to +3.0 L/min). The percentage error was 49%. The concordance rate was 100%. For CNCOcal, the mean difference was −0.3 L/min (±0.5 L/min; −1.2 to +0.7 L/min) with a percentage error of 19%. In this clinical study in cardiothoracic surgery patients, CNCOcal showed good agreement when compared with PAC-CO. For CNCObio, we observed a higher percentage error and good trending ability (concordance rate 100%).

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Acknowledgements

We thank Dr. Doris Flotzinger (CNSystems Medizintechnik AG, Graz, Austria) for her assistance with data extraction. CNSystems Medizintechnik AG (Graz, Austria) provided the technical equipment for the study.

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Authors and Affiliations

  1. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Julia Y. Wagner, Annmarie Körner, Leonie Schulte-Uentrop, Daniel A. Reuter & Bernd Saugel

  2. Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany

    Mathias Kubik & Hermann Reichenspurner

  3. Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Mathias Kubik & Stefan Kluge

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  1. Julia Y. Wagner
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Correspondence to Julia Y. Wagner.

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Conflict of interest

JYW and BS received refunds of travel expenses from CNSystems Medizintechnik AG (Graz, Austria). BS received honoraria for giving lectures for CNSystems Medizintechnik AG (Graz, Austria). For all other authors there is no conflict to disclose. CNSystems Medizintechnik AG (Graz, Austria) provided the technical equipment for the study.

Research involving Human Participants and/or Animals

This method comparison study was reviewed and approved by the ethics committee (Ethikkomission der Ärztekammer Hamburg, Hamburg, Germany). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wagner, J.Y., Körner, A., Schulte-Uentrop, L. et al. A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients. J Clin Monit Comput 32, 235–244 (2018). https://doi.org/10.1007/s10877-017-0027-x

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