Agreement between cardiac output estimation with a wireless, wearable pulse decomposition analysis device and continuous thermodilution in post cardiac surgery intensive care unit patients

Abstract

Abstract Purpose Pulse Decomposition Analysis (PDA) uses integration of the systolic area of a distally transmitted aortic pulse as well as an arterial stiffness estimate to compute cardiac output. We sought to assess agreement of cardiac output (CO) estimation between continuous pulmonary artery catheter (PAC) guided thermodilution (CO-CCO) and a wireless, wearable non-invasive technology that utilizes the Pulse Decomposition Analysis (CO-PDA) method in post-operative cardiac surgery patients. Methods Post processed CO-CCO measurements were compared with CO-PDA measurements in prospectively enrolled adult cardiac surgical intensive care unit patients. Both calibrated and uncalibrated CO-PDA values were compared for accuracy with CO-CCO via a Bland-Altman analysis considering repeated measurements and a concordance analysis with a 10% exclusion zone. Results 259.7 hours of monitoring data from 41 patients matching 15583 data points was analyzed. Mean CO-CCO was 5.55 L/min, while mean values for the uncalibrated CO-PDA were 5.73 L/min (bias +- precision 0.79 ± 1.11 L/min; limits of agreement − 1.43 to 3.01 L/min) and for the calibrated CO-PDA were 5.60 L/min (bias +- precision 0.22 ± 1.03 L/min; limits of agreement − 1.86 to 2.26 L/min). The percentage errors were 37.5% (uncalibrated) and 35.0% (calibrated). CO-CCO correlation with CO-PDA was moderate (0.54 and 0.67, respectively) and concordance was 0.83. Conclusion Cardiac output measured with the CO-PDA agrees with the commonly used CO-CCO PAC continuous thermodilution method. These devices are not interchangeable when using a 30% error threshold though the CO-PDA offers a non-invasive, wireless solution to complement and extend hemodynamic monitoring within and outside the ICU.