Cardiac Output Monitoring in Cardiac Surgery with Cardiopulmonary Bypass

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Cardiac Output Monitoring in Cardiac Surgery
with Cardiopulmonary Bypass
K. Lebedinski, A. Vetchinkin St. Petersburg
2
Circulatory Failure After Cardiac Surgery With CPB

• Hypovolemia
• Vasoplegia
• Rewarming
• SIRS after CPB
• Drug or blood reaction
• Primary Low Cardiac Output
• Ventricular dysfunction
• Surgical problems

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Circulatory Failure Diagnosis
CardiacOutput?
Vascular Tone?
Preload?
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CO measurementSVR calculation
Preload measurement
The Sources of Principal Hemodynamic Variables
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Clinical group 32 ASA III-IV male patients, aged
40-75 Surgery Elective CABG and/or valve
replacement with CPB Methods CO estimation by 6
different methods, in all 913 pair data
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S/5 General Electric, USA
Method Conventional (pulmonary artery)
thermodilution, N246
7

NICO2 Novametrix, USA
Method Partial CO2-rebreathing based on
differential form of Fick equation, N473
8

PiCCO Pulsion, Germany
Method transpulmonary thermodilution followed by
continuous pulse wave contour analysis, N416
9

Diamant-M Russia
Method Impedance Cardiography with on-line
Computer Analysis (Bioimpedance Monitoring), N428
10

Sonoline G60S Siemens, Germany
Method Transesophageal echocardiography (TEE),
N113
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Method Adolf Fick principle (1870), N150
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Correlation Between MethodsBefore CPB

• The best CTD, TPTD, CO2 and IC
• The worst Fick and TEE

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Correlation Between MethodsAfter CPB

• Correlations between CTD, TPTD and CO2 remained
  stable

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Correlation Between MethodsAfter CPB

• IC became inaccurate!

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Correlation Between MethodsAfter CPB

• What about Fick and TEE? Small amount of data
  - ?...

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Conclusions

• The most relevant cardiac output monitoring
  methods in cardiac surgery with cardiopulmonary
  bypass are conventional and transpulmonary
  thermodilution and CO2 partial rebreathing.
• Impedance cardiography, acceptable in non-CPB
  cases, became inaccurate after the bypass.
• Transesophageal EchoCG and Fick method
  demonstrate poor accuracy in clinical settings.

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Thank you for the attention!