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Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

Gutierrez, J; Perry, H; Columb, M; Bampoe, S; Thilaganathan, B; Khalil, A (2019) Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement. Ultrasound Obstet Gynecol, 54 (2). pp. 232-238. ISSN 1469-0705 https://doi.org/10.1002/uog.20142
SGUL Authors: Thilaganathan, Baskaran Khalil, Asma

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Abstract

Objective Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal‐directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non‐invasive (NICOM®) devices, and to assess agreement between the two devices in measuring CO. Methods Simultaneous intraoperative hemodynamic measurements were taken using the LiDCOrapid and NICOM devices, following standardized techniques, in women at high risk of hemodynamic instability undergoing Cesarean section. Agreement in CO measurements between the two devices was assessed using Bland–Altman plots and the agreement:tolerability index (ATI). Agreement analyses were performed for repeated measures in subjects, using centiles. Results From 10 women, 307 paired measurements were analyzed. Mean bias (defined as the mean difference in CO measurements between the LiDCOrapid and NICOM devices) was 3.05 (95% CI, 1.89 to 4.21) L/min. Limits of agreement ranged from −1.58 (95% CI, −4.47 to −0.14) to 7.68 (95% CI, 6.24 to 10.56) L/min. The resulting agreement interval was 9.26 L/min which returned an ATI of 2.3. Conclusions There are large mean differences between CO measurements obtained during Cesarean section using the LiDCOrapid and NICOM hemodynamic monitors in pregnant women at high risk of hemodynamic instability, indicating that they should not be considered interchangeable clinically. There is an unacceptably low level of agreement (ATI > 2) in CO measurements between the devices, conferring a high risk of clinical misclassification during massive hemorrhage.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Gutierrez, J. , Perry, H. , Columb, M. , Bampoe, S. , Thilaganathan, B. and Khalil, A. (2019), Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement. Ultrasound Obstet Gynecol, 54: 232-238, which has been published in final form at https://doi.org/10.1002/uog.20142. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: Caesarean Section, Cardiac output, Non-invasive monitoring, haemorrhage, pregnancy, 1114 Paediatrics And Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
5 August 2019Published
11 July 2019Published Online
2 October 2018Accepted
Publisher License: Publisher's own licence
PubMed ID: 30302868
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110441
Publisher's version: https://doi.org/10.1002/uog.20142

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