Validation of a new arterial pulse contour-based cardiac output device

Objective. To evaluate the accuracy and precision of an arterial pulse contour-based continuous cardiac output device (Vigileo). Vigileo cardiac output (VigileoCO) was compared with intermittent transpulmonary thermodilution cardiac output (TPCO) and an established arterial pulse contour-based cardiac output (PCCO). Design: Prospective clinical study. Setting: University hospital. Patients: Twenty-two patients undergoing coronary artery bypass graft surgery. Interventions: Defined volume load during surgery and in the postoperative period. Measurements and Main Results. We obtained 184 pairs of VigileoCO and TPCO, 140 pairs of VigileoCO and PCCO, and 140 pairs of PCCO and TPCO. Measurements were performed after induction of anesthesia (T1), after sternotomy (T2), immediately after (T3) and 20 mins after volume challenge with 10 mL.kg(-1) hydroxyethyl starch 6% (T4), 15 mins after coronary pulmonary bypass (T5), after retransfusion of autologous blood JIB), after arrival at the intensive care unit (T7), and immediately after (T8) and 20 mins after (T9) a second volume load with 10 mL.kg-1 hydroxyethyl starch 6%. TPCO was used to calibrate PCCO. For pooled data, including uncalibrated PCCO data immediately after weaning from coronary pulmonary bypass (T5), the correlation coefficient of TPCO vs. VigileoCO, PCCO vs. VigileoCO, and TPCO vs. PCCO was 0.75, 0.60, and 0.75 respectively. Bland-Altman analysis showed a bias of 0.00, -0.01, and 0.02 L.min(-1), the precision (=SD) was 0.87, 1.08, and 0.93 L.min(-1), and the mean error was 33%, 40%, and 35%. When we compared calibrated PCCO values (T2-T4, T6, T7-9), the correlation coefficients of PCCO-VigileoCO and TPCO-PCCO were 0.72 and 0.85, bias was -0.16 and 0.19 L.min(-1), and mean error was 33% and 27%, respectively. Best correlations and the least differences between TPCO and VigileoCO were observed in postbypass closed-chest conditions and in the intensive care unit. Conclusions: Our results showed that VigileoCO enables clinically acceptable assessment of cardiac output in postbypass closed-chest conditions and during stable conditions in the intensive care unit.