Accuracy of Estimated Continuous Cardiac Output Monitoring (esCCO) Using Pulse Wave Transit Time (PWTT) Compared to Arterial Pressure-based CO (APCO) Measurement during Major Surgeries

Malini Joshi; Resham Rathod; Shilpushp J Bhosale; Atul P Kulkarni

doi:10.5005/jp-journals-10071-24158

Accuracy of Estimated Continuous Cardiac Output Monitoring (esCCO) Using Pulse Wave Transit Time (PWTT) Compared to Arterial Pressure-based CO (APCO) Measurement during Major Surgeries

Indian J Crit Care Med. 2022 Summer;26(4):496-500. doi: 10.5005/jp-journals-10071-24158.

Authors

Malini Joshi¹, Resham Rathod¹, Shilpushp J Bhosale², Atul P Kulkarni³

Affiliations

¹ Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
² Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
³ Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Abstract

Background: Pulse wave transit time is a novel method of estimating continuous cardiac output (esCCO). Since there are not many studies evaluating esCCO, we compared it with arterial pressure based cardiac output (APCO) method (FloTrac).

Methods: In this prospective single-center observational study, we included 50 adult patients planned to undergo supramajor oncosurgeries, where major blood loss and extensive fluid shifts were expected. Cardiac output (CO) measurements were obtained by both methods at five distinct time points, giving us 250 paired readings of stroke volume index (SVI) and cardiac index (CI). We analyzed these readings using Pearson's correlation coefficient and Bland-Altman plots, along with other appropriate statistical tests.

Results: There was significant correlation between CI and SVI measured by the esCCO and APCO. Bland-Altman plot analysis for CI showed a bias of -0.44 L/minute/m², precision of 0.74, and the limits of agreement of -1.89 and +1.01, while the percentage error was 46.29%. Bland-Altman analysis for SVI showed a bias -5.07 mL with a precision of 9.36, and the limits of agreement to be -23.4 to +13.28. The percentage error was 46.56%.

Conclusion: This study demonstrated that esCCO tended to underestimate the CI to a large degree, particularly while estimating the cardiac output in the lower range. We found that the limits of agreement between two methods were wide, which are not likely to be clinically acceptable. Further studies with larger number of data points, obtained in a similar subset of patients, for cardiac output measurement in the perioperative period will certainly help determine if pulse wave transit time (PWTT) is here to stay (CTRI No.: CTRI/2019/08/020543).

How to cite this article: Joshi M, Rathod R, Bhosale SJ, Kulkarni AP. Accuracy of Estimated Continuous Cardiac Output Monitoring (esCCO) Using Pulse Wave Transit Time (PWTT) Compared to Arterial Pressure-based CO (APCO) Measurement during Major Surgeries. Indian J Crit Care Med 2022;26(4):496-500.

Keywords: Arterial pressure-based cardiac output; Bias; Estimated continuous cardiac output; Limits of agreement; Percentage error; Precision; Pulse wave transit time.