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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
INVITED COMMENTARY  
Year : 2014  |  Volume : 17  |  Issue : 4  |  Page : 278
Comparison between continuous noninvasive estimated cardiac output by pulse wave transit time and thermodilution method


Department of Critical Care and Anesthesiology, Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector 38, Gurgaon, Haryana, India

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Date of Web Publication1-Oct-2014
 

How to cite this article:
Mehta Y. Comparison between continuous noninvasive estimated cardiac output by pulse wave transit time and thermodilution method. Ann Card Anaesth 2014;17:278

How to cite this URL:
Mehta Y. Comparison between continuous noninvasive estimated cardiac output by pulse wave transit time and thermodilution method. Ann Card Anaesth [serial online] 2014 [cited 2019 Dec 6];17:278. Available from: http://www.annals.in/text.asp?2014/17/4/278/142060


An ideal cardiac output (CO) monitor should be minimally or noninvasive, continuous, cost effective, reproducible particularly during various physiological states and have a fast response time. [1] Methods of CO monitoring are broadly classified as: [2] Invasive, minimally invasive and noninvasive.

Pulmonary artery catheter (PAC) thermodilution is still considered the "gold standard" for CO estimation since its invention by Swan et al. [3] Gore et al. [4] and SUPPORT trial [5] showed that PAC use increased mortality after myocardial infarction, therefore, newer non or less invasive devices are being developed and validated in different clinical scenarios.

In this issue Sinha et al. [6] have tried to validate/correlate pulse wave transit time (PWTT) technique with eeCCO (estimated continuous cardiac output life sciences monitoring system which estimates the PWTT from the time gap between electrocardiogram (ECG)-R wave and the peripheral pulse detected by pulse oximeter in a mixed population of patients of coronary artery bypass graft, aortic valve replacement (AVR), aortic reconstruction and liver transplant. Liver transplant patients have a low systemic vascular resistance and may have a high output state. [7] This would affect the PWWT as would it happen in AVR due to high pulse pressure.

In this study, the esCCO estimated higher or lower values of CO by error almost equal to - of the actual CO. Seventy percent over/under estimation of CO can significantly alter the course of therapy, e.g. inotropes, vasodilators or volume and subsequently affect the clinical outcome with disastrous results.

The main advantage of PWTT technique is the noninvasiveness. You only need ECG and SpO 2 /noninvasive blood pressure to get the stroke volume and CO but the correlation between PAC and this has to be good enough with minimal bias, good precision and limits of agreement to be clinically reliable.

It is a well-planned and conducted paper with negative results. Authors have discussed the statistical method in detail with unbiased conclusions explaining the pitfalls of statistics, e.g. low bias in their paper! Till further work shows it. Otherwise, the jury is still out on PWTT technology for CO estimation.

 
   References Top

1.de Waal EE, Wappler F, Buhre WF. Cardiac output monitoring. Curr Opin Anaesthesiol 2009;22:71-7.  Back to cited text no. 1
    
2.Mehta Y, Arora D. Newer methods of cardiac output monitoring. World J Cardiol 2014:6. [In press].  Back to cited text no. 2
    
3.Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970;283:447-51.  Back to cited text no. 3
[PUBMED]    
4.Gore JM, Goldberg RJ, Spodick DH, Alpert JS, Dalen JE. A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction. Chest 1987;92:721-7.  Back to cited text no. 4
    
5.Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 1996;276:889-97.  Back to cited text no. 5
    
6.Sinha CA, Singh MP, Grewal N, Aman M, Dubowitz G. Comparison between continuous non invasive estimated cardiac output by pulse wave transit time and thermodilution method. Ann Card Anaesth 2014;17:273-9.  Back to cited text no. 6
  Medknow Journal  
7.Plotkin JS, Johnson LB, Rustgi V, Kuo PC. Coronary artery disease and liver transplantation: The state of the art. Liver Transpl 2000;6:S53-6.  Back to cited text no. 7
    

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