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

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Presentation transcript:

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

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

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

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

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

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

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

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

Diamant-MRussia 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, CO 2 and IC The best: CTD, TPTD, CO 2 and IC The worst: Fick and TEE The worst: Fick and TEE

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

Correlation Between Methods: After CPB IC became inaccurate! IC became inaccurate!

Correlation Between Methods: After CPB What about Fick and TEE? Small amount of data - ?... 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 CO 2 partial rebreathing.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.Impedance cardiography, acceptable in non- CPB cases, became inaccurate after the bypass. Transesophageal EchoCG and Fick method demonstrate poor accuracy in clinical settings.Transesophageal EchoCG and Fick method demonstrate poor accuracy in clinical settings.

Thank you for the attention!