Cardiac Index Validation Using the Pressure Recording Analytic Method in Unstable Patients

Alberto Zangrillo, Giulia Maj, Fabrizio Monaco, Anna Mara Scandroglio, Massimiliano Nuzzi, Valentina Plumari, Isotta Virzo, Elena Bignami, Giuseppina Casiraghi, Giovanni Landoni

Research output: Contribution to journalArticlepeer-review


Objective: The authors investigated the accuracy and precision of the pressure recording analytic method (PRAM) in cardiac index measurement compared with thermodilution in unstable patients, a setting in which minimally invasive monitoring devices often fail. Design: Criterion standard. Setting: Intensive care unit. Patients: Thirty-two consecutive patients with low cardiac output syndrome treated with an intra-aortic balloon pump and/or high doses of inotropic drugs but without atrial fibrillation were studied after cardiac surgery. Interventions: None. Pulmonary and radial artery catheters were already in situ for clinical reasons. Measurements and Main Results: Four patients (12.5%) were excluded from the study because of artifacts caused by under- or overdamping of the arterial pressure monitoring system. The authors performed 3 injections of the thermal indicator in 5 minutes through the pulmonary artery catheter. Mean cardiac index values of 12 consecutive beats were considered for the PRAM. A significant correlation was found between the cardiac index assessed by thermodilution and PRAM (r = 0.72, p <0.001). The mean bias between the 2 techniques was 0.072 ± 0.41 L/min/m2 with lower and upper 95% limits of confidence of -0.089 and 0.233 L/min/m2, respectively. The percentage error was 30%. Sufficient agreement between the two techniques was evidenced by the Bland-Altman plot with only two points above the limits of agreement. Conclusions: This study showed that PRAM, a minimally invasive method for cardiac index assessment, is clinically useful even in unstable patients such as those receiving intra-aortic balloon pump and/or ongoing high doses of a inotropic drugs because of a low cardiac output syndrome but without atrial fibrillation.

Original languageEnglish
Pages (from-to)265-269
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number2
Publication statusPublished - Apr 2010


  • cardiac index
  • cardiac surgery
  • hemodynamic monitoring
  • pressure recording analytic method (PRAM)
  • pulse contour analysis
  • unstable patients
  • validation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine
  • Medicine(all)


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