University of Oulu

Ylikauma, L.A., Ohtonen, P.P., Erkinaro, T.M. et al. Bioreactance and fourth-generation pulse contour methods in monitoring cardiac index during off-pump coronary artery bypass surgery. J Clin Monit Comput 36, 879–888 (2022).

Bioreactance and fourth-generation pulse contour methods in monitoring cardiac index during off-pump coronary artery bypass surgery

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Author: Ylikauma, Laura Anneli1; Ohtonen, Pasi Petteri1,2; Erkinaro, Tiina Maria1;
Organizations: 1Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
2Division of Operative Care, Oulu University Hospital, Oulu, Finland
3Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki University Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-09-20


The pulmonary artery catheter (PAC) is considered the gold standard for cardiac index monitoring. Recently new and less invasive methods to assess cardiac performance have been developed. The aim of our study was to assess the reliability of a non-invasive monitor utilizing bioreactance (Starling SV) and a non-calibrated mini-invasive pulse contour device (FloTrac/EV1000, fourth-generation software) compared to bolus thermodilution technique with PAC (TDCO) during off-pump coronary artery bypass surgery (OPCAB). In this prospective study, 579 simultaneous intra- and postoperative cardiac index measurements obtained with Starling SV, FloTrac/EV1000 and TDCO were compared in 20 patients undergoing OPCAB. The agreement of data was investigated by Bland–Altman plots, while trending ability was assessed by four-quadrant plots with error grids. In comparison with TDCO, Starling SV was associated with a bias of 0.13 L min−1 m−2 (95% confidence interval, 95% CI, 0.07 to 0.18), wide limits of agreement (LOA, − 1.23 to 1.51 L min−1 m−2), a percentage error (PE) of 60.7%, and poor trending ability. In comparison with TDCO, FloTrac was associated with a bias of 0.01 L min−1 m−2 (95% CI − 0.05 to 0.06), wide LOA (− 1.27 to 1.29 L min−1 m−2), a PE of 56.8% and poor trending ability. Both Starling SV and fourth-generation FloTrac showed acceptable mean bias but imprecision due to wide LOA and high PE, and poor trending ability. These findings indicate limited reliability in monitoring cardiac index in patients undergoing OPCAB.

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Series: Journal of clinical monitoring and computing
ISSN: 1387-1307
ISSN-E: 1573-2614
ISSN-L: 1387-1307
Volume: 36
Issue: 3
Pages: 879 - 888
DOI: 10.1007/s10877-021-00721-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open access funding provided by University of Oulu including Oulu University Hospital. Financial support was provided from the sources of Oulu University Hospital. No external funding was received.
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