TY - EJOU
AU - Seckeler, Michael D.
AU - Typpo, Katri
AU - Deschenes, Jendar
AU - Higgins, Ruth
AU - Samson, Ricardo
AU - Lichtenthal, Peter
TI - Inaccuracy of a continuous arterial pressure waveform monitor when used for congenital cardiac catheterization
T2 - Congenital Heart Disease
PY - 2017
VL - 12
IS - 6
SN - 1747-0803
AB - Objective: To determine the accuracy of a continuous cardiac output monitor (FloTrac sensor) for
measuring cardiac index in children with congenital heart disease undergoing cardiac catheterization. Cardiac index is a critical hemodynamic parameter measured during catheterizations in
children with congenital heart disease. This has been challenging to measure accurately and many
clinicians rely on predictive equations for calculating cardiac index.
Design: Prospective, nonrandomized trial.
Setting: Tertiary care congenital heart center.
Patients: Consecutive participants ≤18 years old undergoing clinically indicated cardiac catheterizations from September 2014 through August 2015.
Interventions: Oxygen consumption was measured using the Vmax Encore 229 monitor attached
to the ventilator circuit. The FloTrac transducer with third generation software was connected to
a pigtail catheter in the descending aorta and cardiac index was obtained.
Outcome Measures: Cardiac index by the Fick equation using measured oxygen consumption was
compared to cardiac index from the FloTrac sensor using paired t-test and Bland–Altman analysis.
Results: 39 participants (median age 5.1 years, 1.5-18.3, 64% female) were studied. Cardiac index
by FloTrac was higher than cardiac index by Fick (6.4 ± 3.4 vs 3.7 ± 1.2 L/min/m2, P < .001).
Bland–Altman analysis showed a consistent overestimation of cardiac index by FloTrac which
worsened as cardiac index increased (mean bias 2.7 L/min/m2
, 95% limits of agreement 24.2, 9.5).
Conclusions: The results of this study show that the FloTrac sensor provides cardiac index measures which are not accurate enough to justify use in children with congenital heart disease
undergoing catheterization. Further studies may allow for modifications of the algorithms to obtain
more accurate cardiac index in this population.
KW - catheterization
KW - congenital heart disease
KW - diagnostic
KW - hemodynamics
KW - pediatrics
DO - 10.1111/chd.12517