Correlation of Cardiac Output by Arterial Contour-Derived Cardiac Output Monitor Versus Pulmonary Artery Catheter in Liver Transplant: Experience at an Indian Center

OBJECTIVE: Arterial pulse-derived cardiac output monitors are routinely employed to guide hemodynamic management during liver transplant surgery. In this study, we sought to assess the reliability by evaluating the agreement of the cardiac output measured by the FloTrac Vigileo versus pulmonary artery catheter (continuous cardiac output) at specified times during liver transplant. METHODS: Liver transplant database with cardiac output values measured by FloTrac Vigileo and continuous cardiac output was analyzed retrospectively at a tertiary care hospital. Data were compared at T0: baseline, T1: 1 hour in dissection phase, T2: anhepatic phase, T3: portosystemic shunt, T4: reperfusion, T5: 1 hour after reperfusion, and T6: skin closure. Statistical analysis was done using Bland–Altman analysis and percentage error (<30%) to assess the agreement between cardiac output measured by 2 techniques, Lin’s concordance correlation coefficient for quantifying the agreement and 4-quadrant plots to compare the trends of cardiac output. RESULTS: Bland–Altman analysis showed mean cardiac output ± standard deviation L min(-1) (95% CI) at T0: 0.2 ± 2.09 (−3.9 to 4.3), T1: 0.53 ± 3.0 (−5.4 to 6.4), T2: 0.47 ± 2.1(−3.7 to 4.6), T3: 0.31 ± 1.9 (−3.4 to 4.0), T4: 0.44 ± 2.15 (−3.8 to 4.7), T 5:0.69 ± 1.9. (−2.9 to 4.3), and at T6: 0.43 ± 2.25 (−4.0 to 4.8). Percentage error was 44%-72% and concordance correlation coefficient was poor (<0.65) at all points. CONCLUSIONS: There is poor agreement between the cardiac output measured by FloTrac and pulmonary artery catheter among liver transplant recipients. The need for superior hemodynamic monitoring is mandated in liver transplant.