CARDIAC-OUTPUT DURING LIVER-TRANSPLANTATION

Purpose: Measurement of cardiac output is an essential part of anaesth etic practice in patients undergoing major operative procedures. A the rmodilution technique, using a pulmonary artery catheter is currently accepted as the gold standard in clinical practice. However its use is associated with several limitations. Method: In this prospective rand omised controlled study measurement of cardiac output, an oesophageal Doppler monitor (ODM) was compared with the thermodilution technique i n 18 patients undergoing orthotopic liver transplantation. Measurement s were taken during the three phases of liver transplantation, I) diss ection phase (three measurements), ii) anhepatic phase (four) and iii) reperfusion phase (six). Results: There were no differences observed between the two measurements at any of the times studied and a strong correlation was observed (r = 0.714; P < 0.00001), However, when the d ata was analysed using Bland and Altman analysis, while the mean diffe rence was small (0.07 l.min(-1)) it was > 2 l.min(-1) in one third of measurements recorded i,e., the bias was near zero but the precision w as large, No consistent differences were seen using the two methods in individual patients. Conclusion: The use of the ODM results in cardia c output measurements which are considerably different from those obta ined using thermodilution and its use cannot be recommended in patient s undergoing orthotopic liver transplantation.