Four different methods of measuring cardiac index during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is high risk extensive abdominal surgery. During high risk surgery less-invasive methods for measurement of cardiac index (CI) have been widely used in operating theater. We investigated the accuracy of CI derived from different methods (FroTrac, ProAQT, ClearSight and arterial pressure waveform analysis (APWA) from PICCO) and compared them to transpulmonary thermodilution (TPTD) during CRS and HIPEC perioperative and in ICU. Methods 25 patients scheduled for CRS-HIPEC were enrolled in this study. On nine predefined time points (T1-T9) simultaneous hemodynamic measurements were performed in the operating room and intensive care unit. Absolute and relative changes CI were analyzed using Bland-Altman plot, four quadrant plot and interchangeability. Results Comparing CI values, the mean bias was -0.1 L/min/m2 for ClearSight, ProAQT and APWA and -0.2 L/min/m2 for FloTrac compared with TPTD. All devices had large limits of agreement and high percentage of error 50,54,36 and 50%. Interchangeability 36%,47%,40% and 72% for respectively ClearSight, FloTrac, ProAQT and APWA. Trending capabilities expressed as concordance using clinical significant CI changes were: ClearSight 85%, FloTrac 76%, ProAQT 76%, and APWA 66%. Mean angular bias ± radial LoA were -7o±39o,-19o±38o,-13o±41o and -15o±39o respectively. Interchangeability in trending showed low percentages of interchangeable and gray zone data pairs for all devices. Conclusions During CRS-HIPEC, ClearSight, FloTrac and ProAQT systems were not able to reliably measure CI compared to TPTD. Reproducibility of changes over time using concordance, angular bias, radial LoA and interchangeability in trending of all devices is unsatisfactory.