Simultaneous Evaluation of Pulse Contour Devices Using an Innovative Hemodynamic Simulation Bench

<b>Introduction:</b> Evaluating cardiovascular function is crucial in the care of critically ill patients. Recent advancements in continuous cardiac output (CO) monitoring have led to the emergence of several arterial pulse contour devices. To effectively compare the accuracy of these devices, a comprehensive assessment is necessary. However, no experimental studies were found that have evaluated these devices in a controlled setting. <b>Methods:</b> In this innovative bench study, we used a Donovan mock circulatory system in conjunction with a total artificial heart (TAH-t) to simultaneously generate several comparable arterial waveforms and compared CO estimates from three different pulse contour devices: FloTrac™ (Vigileo™, v1.8 4th generation, Edwards LifeSciences, Irvine, CA, USA), proAQT™ (PulsioFlex™, Pulsion Medical Systems, Munich, Germany), and LiDCO™ Plus (LiDCO™, LidCO Ltd., Cambridge, UK). These devices underwent several hemodynamic challenges (HCs), including decreased preload, decreased afterload, and increased heart rate. To evaluate the degree of agreement between the devices, we performed a Bland-Altman analysis for the paired devices. The interclass comparison, error percentage, and variation coefficient for each device were also assessed. <b>Results:</b> The present study first tested the comparability between the three additional arterial line waveforms, and the arterial control line was simultaneously generated with the hemodynamic simulation bench. Comparing the reference values of the dP/dt and sAUC pulse pressure, we found no clinically significant difference between the simultaneously generated arterial waveforms. The different pulse contour devices were then each connected to the arterial lines, with the performance of HCs. HC1 with a decreased preload revealed that CO estimates significantly decreased compared to the baseline values: 3.2 ± 0.06 L.min^-1, 4.7 ± 0.05, 4.3 ± 0.07, and 4.0 ± 0.05 for reference methods FloTrac™, PulsioFlex™, and LiDCO™, respectively. HC2 with an increased heart rate revealed CO estimates with FloTrac™, PulsioFlex™, and LiDCO™-6.0 ± 0.03, 6.6 ± 0.06, and 6.0 ± 0.05 L.min^-1, respectively-when the CO estimate was 5.6 ± 0.2. HC3 with a decreased afterload that significantly increased CO estimates compared to the baseline with FloTrac™, PulsioFlex™, and LiDCO™-7.0 ± 0.18, 6.6 ± 0.15, and 7.1 ± 0.30 L.min^-1, respectively-when the CO estimate with the reference method did not change significantly (from 5.90 ± 0.13 to 5.94 ± 0.11 <i>p</i> = 0.26). The devices' degree of agreement was estimated with Bland-Altman analysis. <b>Conclusions:</b> The Donovan Mock Circulatory System with SynCardia TAH-t can be used as an innovative experimental hemodynamic simulation bench. It was proven to be stable, accurate, and reliable in generating several controlled pulse pressure waveforms, while many parameters could be changed, such as the preload, heart rate, or afterload. This enables a simultaneous evaluation of different pulse contour devices submitted to several HCs. This is of interest for clinicians to better understand the underlying principles and realistically compare the performance and potentially inherent limitations of pulse contour devices experimentally in a controlled simulated environment.