Comparison of trend performance of esCCO and APCO in kidney transplantation

Perioperative goal directed therapy (GDT) based on measurement of stroke volume (SV) is expected to improve postoperative outcome1). A device that can accurately measure stroke volume (SV) during surgery and that is both minimally-invasive and low cost is ideal. Many methods have been developed to measure SV less-invasively and continuously; pulse contour and intrathoracic impedance methods have been widely used in clinical practice. Estimated continuous cardiac output (esCCO, Nihon Kohden Corporation, Tokyo, Japan) is a technology that continuously and non-invasively measures SV based on pulse wave transit time (PWTT), and uses only information derived from the electrocardiogram (ECG), pulse oximeter (SpO2) and blood pressure. With esCCO, continuous SV is available in surgeries where ECG, SpO2 and blood pressure are measured. esCCO has been evaluated in a multi-center study involving 7 facilities in Japan. In the multi-center study, Yamada, et. al. used intermittent cold bolus thermodilution (ICO) for initial calibration and compared esCCO with ICO2). They concluded that the accuracy of esCCO is clinically comparable to ICO, but commented that esCCO could not be considered self-contained and non-invasive because an invasive method is used for initial calibration2). Ishihara, et al. reported on the performance of esCCO calibrated non-invasively with patientʼs demographic data. The authors suggested that the ability of esCCO to measure trends in cardiac output (CO) is comparable with the arterial pressure-based cardiac output (APCO) by referring to other papers3). In this case report, we evaluated the performance of non-invasively measured esCCO to trend changes in SV as compared to APCO (FloTrac/Vigileo, Edwards Lifesciences, Irvine, CA, USA).