Download After CPB

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 CPB
• Drug or blood reaction
Primary Low Cardiac Output:
• Ventricular dysfunction
• Surgical problems
Circulatory Failure: Diagnosis
Cardiac
Output? Vascular
Tone?
Preload?
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 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
NICO2
Novametrix, USA
Method: Partial CO2-rebreathing based
on differential form of Fick equation,
N=473
PiCCO
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
Sonoline G60S
Siemens, Germany
Method: Transesophageal
echocardiography (TEE), N=113
Method: Adolf Fick principle (1870),
N=150
Correlation Between Methods:
Before CPB
• The best: CTD, TPTD, CO2 and IC
• The worst: Fick and TEE
Correlation Between Methods:
After CPB
• Correlations between CTD, TPTD
and CO2 remained stable
Correlation Between Methods:
After CPB
• IC became inaccurate!
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 bypass are conventional and
transpulmonary thermodilution and CO2 partial
rebreathing.
• Impedance cardiography, acceptable in nonCPB cases, became inaccurate after the bypass.
• Transesophageal EchoCG and Fick method
demonstrate poor accuracy in clinical settings.
Thank you
for the
attention!