Cardiac Output Monitoring in Cardiac Surgery with Cardiopulmonary

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Cardiac Output Monitoring in Cardiac Surgery with Cardiopulmonary Bypass K. Lebedinski, A. Vetchinkin St.

Cardiac Output Monitoring in Cardiac Surgery with Cardiopulmonary Bypass K. Lebedinski, A. Vetchinkin St. Petersburg

Circulatory Failure After Cardiac Surgery With CPB Hypovolemia Vasoplegia: • Rewarming • SIRS after

Circulatory Failure After Cardiac Surgery With CPB Hypovolemia Vasoplegia: • Rewarming • SIRS after CPB • Drug or blood reaction Primary Low Cardiac Output: • Ventricular dysfunction • Surgical problems

Circulatory Failure: Diagnosis Cardiac Vascular Output? Tone? Preload?

Circulatory Failure: Diagnosis Cardiac Vascular Output? Tone? Preload?

The Sources of Principal Hemodynamic Variables CO: measurement SVR: calculation Preload: measurement

The Sources of Principal Hemodynamic Variables CO: measurement SVR: calculation Preload: measurement

Clinical group: 32 ASA III-IV male patients, aged 40 -75 Surgery: Elective CABG and/or

Clinical group: 32 ASA III-IV male patients, aged 40 -75 Surgery: Elective CABG and/or valve replacement with CPB Methods: CO estimation by 6 different methods, in all 913 pair data

S/5 General Electric, USA Method: Conventional (pulmonary artery) thermodilution, N=246

S/5 General Electric, USA Method: Conventional (pulmonary artery) thermodilution, N=246

NICO 2 Novametrix, USA Method: Partial CO 2 -rebreathing based on differential form of

NICO 2 Novametrix, USA Method: Partial CO 2 -rebreathing based on differential form of Fick equation, N=473

Pi. CCO Pulsion, Germany Method: transpulmonary thermodilution followed by continuous pulse wave contour analysis,

Pi. CCO Pulsion, Germany Method: transpulmonary thermodilution followed by continuous pulse wave contour analysis, N=416

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

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

Sonoline G 60 S Siemens, Germany Method: Transesophageal echocardiography (TEE), N=113

Sonoline G 60 S Siemens, Germany Method: Transesophageal echocardiography (TEE), N=113

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

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

Correlation Between Methods: Before CPB • The best: CTD, TPTD, CO 2 and IC

Correlation Between Methods: Before CPB • The best: CTD, TPTD, CO 2 and IC • The worst: Fick and TEE

Correlation Between Methods: After CPB • Correlations between CTD, TPTD and CO 2 remained

Correlation Between Methods: After CPB • Correlations between CTD, TPTD and CO 2 remained stable

Correlation Between Methods: After CPB • IC became inaccurate!

Correlation Between Methods: After CPB • IC became inaccurate!

Correlation Between Methods: After CPB • What about Fick and TEE? Small amount of

Correlation Between Methods: After CPB • What about Fick and TEE? Small amount of data - ? . . .

Conclusions: • The most relevant cardiac output monitoring methods in cardiac surgery with cardiopulmonary

Conclusions: • The most relevant cardiac output monitoring methods in cardiac surgery with cardiopulmonary bypass are conventional and transpulmonary thermodilution and CO 2 partial rebreathing. • Impedance cardiography, acceptable in non. CPB cases, became inaccurate after the bypass. • Transesophageal Echo. CG and Fick method demonstrate poor accuracy in clinical settings.

Thank you for the attention!

Thank you for the attention!

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