Cardiac Output Cardiac Output

Monitoring in Cardiac Monitoring in Cardiac

Surgery with Surgery with

Cardiopulmonary BypassCardiopulmonary Bypass

K. Lebedinski, A. VetchinkinK. Lebedinski, A. Vetchinkin

St. PetersburgSt. Petersburg

Circulatory Failure After Circulatory Failure After Cardiac Surgery With CPBCardiac Surgery With CPB

HypovolemiaHypovolemiaVasoplegia:Vasoplegia:

• RewarmingRewarming• SIRS after CPBSIRS after CPB• Drug or blood reactionDrug or blood reaction

Primary Low Cardiac Output:Primary Low Cardiac Output:• Ventricular dysfunctionVentricular dysfunction• Surgical problemsSurgical problems

Circulatory Failure: DiagnosisCirculatory Failure: Diagnosis

CardiacOutput?Vascular

Tone?Preload?

COCO: :

measurementmeasurement

SVRSVR: : calculation calculation

PreloadPreload: :

measurementmeasurement

The Sources of Principal The Sources of Principal Hemodynamic VariablesHemodynamic Variables

Clinical group:Clinical group:

32 ASA III-IV male patients, aged 32 ASA III-IV male patients, aged 40-7540-75

Surgery:Surgery:

Elective CABG and/or valve Elective CABG and/or valve replacement with CPBreplacement with CPB

Methods:Methods:

CO estimation by 6 different CO estimation by 6 different methods,methods,

in all 913 pair datain all 913 pair data

Method: Conventional (pulmonary Method: Conventional (pulmonary artery) thermodilution, N=246artery) thermodilution, N=246

S/5S/5

General Electric, General Electric, USAUSA

Method: Partial COMethod: Partial CO22-rebreathing -rebreathing based on differential form of based on differential form of Fick equation, N=473Fick equation, N=473

NICONICO2 2

Novametrix, Novametrix, USAUSA

PiCCOPiCCO

Pulsion, Pulsion, GermanyGermany

Method: transpulmonary Method: transpulmonary thermodilution followed by thermodilution followed by continuous pulse wave contour continuous pulse wave contour analysis, N=416analysis, N=416

Diamant-MDiamant-M

RussiaRussia

Method: Impedance Method: Impedance Cardiography with on-line Cardiography with on-line Computer Analysis Computer Analysis (Bioimpedance Monitoring), (Bioimpedance Monitoring), N=428N=428

Sonoline G60SSonoline G60S

Siemens, GermanySiemens, Germany

Method: Transesophageal Method: Transesophageal echocardiography (TEE), N=113echocardiography (TEE), N=113

Method: Adolf Fick principle Method: Adolf Fick principle (1870), N=150(1870), N=150

Correlation Between Correlation Between Methods:Methods:

Before CPBBefore CPB

• The best: CTD, TPTD, COThe best: CTD, TPTD, CO22 and and ICIC

• The worst: Fick and TEEThe worst: Fick and TEE

Correlation Between Correlation Between Methods:Methods:After CPBAfter CPB

• Correlations between CTD, Correlations between CTD, TPTD and COTPTD and CO22 remained stable remained stable

Correlation Between Correlation Between Methods:Methods:After CPBAfter CPB

• IC became inaccurate!IC became inaccurate!

Correlation Between Correlation Between Methods:Methods:After CPBAfter CPB

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

Conclusions:Conclusions:• The most relevant cardiac output monitoring methods The most relevant cardiac output monitoring methods

in cardiac surgery with cardiopulmonary bypass are in cardiac surgery with cardiopulmonary bypass are conventional and transpulmonary thermodilution and conventional and transpulmonary thermodilution and COCO2 2 partial rebreathing. partial rebreathing.

• Impedance cardiography, acceptable in non-CPB Impedance cardiography, acceptable in non-CPB cases, became inaccurate after the bypass. cases, became inaccurate after the bypass.

• Transesophageal EchoCG and Fick method Transesophageal EchoCG and Fick method demonstrate poor accuracy in clinical settings.demonstrate poor accuracy in clinical settings.

Thank youThank you

for the for the attention!attention!