Critical Care

, 18:P142 | Cite as

Performance of pulse contour and pulse wave transit time-based continuous cardiac output analyses: clinical validation of two methods in Thai patients undergoing cardiac surgery

  • P Wacharasint
  • P Kunakorn
  • P Pankongsap
Open Access
Poster presentation


Cardiac Output Coronary Artery Bypass Graft Cardiopulmonary Bypass Radial Artery Output Measurement 
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The aim was to evaluate the performance of arterial pressure-based cardiac output (APCO) [1] and pulse wave transit time- based cardiac output (esCCO) [2] monitors in Thai patients undergoing coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass.


We studied 50 Thai surgical patients undergoing CABG with cardiopulmonary bypass and requiring pulmonary artery catheter and radial artery catheter placement as a standard of clinical care. All patients were measured for APCO using the Vigileo/FloTrac and for esCCO using the esCCO monitoring system. The data were compared with thermodilution cardiac output (TDCO) monitoring as a reference method, simultaneously at pre-induction, post-induction, and every 30 minutes thereafter until the completion of the surgery. The bias and precision were assessed using Bland-Altman analysis.


In total, 310 pairs of simultaneous measurements of APCO versus TDCO and 303 pairs of esCCO versus TDCO were obtained from 50 patients. Both APCO (r = 0.53, P < 0.0001) and esCCO values (r = 0.56, P < 0.0001) were correlated with TDCO values. Either of the changes in APCO (r = 0.63, P < 0.0001) or any changes in esCCO (r = 0.60, P < 0.0001) were correlated with changes in TDCO. For APCO relative to TDCO, the bias, precision, and the limits of agreement were 0.70, 1.63, and -2.5 to 3.9 l/minute, while those of esCCO were 1.20, 1.59, and -1.9 to 4.3 l/ minute, respectively. Comparisons of the bias of APCO and esCCO revealed a level of significance of P < 0.001.


Despite the overestimation of cardiac output measurements, APCO and esCCO calibrated with patient information has shown an acceptable trend as compared with TDCO in Thai patients undergoing CABG with cardiopulmonary bypass. Compared with esCCO, APCO demonstrated no significant differences of precision; however, a lower mean bias was exhibited.


  1. 1.
    Biancofiore G, et al.: Br J Anaesth. 2009, 102: 47-54. 10.1093/bja/aen343CrossRefPubMedGoogle Scholar
  2. 2.
    Ishihara H, et al.: J Clin Monit Comput. 2004, 18: 313-320. 10.1007/s10877-005-2452-5CrossRefPubMedGoogle Scholar

Copyright information

© Wacharasint et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • P Wacharasint
    • 1
  • P Kunakorn
    • 1
  • P Pankongsap
    • 1
  1. 1.Phramongkutklao HospitalBangkokThailand

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