Accuracy and Clinical Utility of Electrical Cardiometry versus Pulse Contour Analysis for Cardiac Index Monitoring in Major Abdominal Surgery: A prospective observation trial

Background Adequate perioperative hemodynamic management is essential to prevent organ hypoxia. Measuring the cardiac index (CI) provides important information. Electrical cardiometry (EC) has been introduced as a non-invasive alternative for CI monitoring, but existing data of its utility and agreement with pulse contour analysis (PCA) in major abdominal surgery is limited. Methods In this prospective observational study, 54 patients undergoing major abdominal surgery with concurrent advanced hemodynamic monitoring were included. CI was measured using EC and PCA. Time-weighted averages (TWA), time below threshold (TBT), and signal quality index (SQI) were analyzed. Agreement between EC and PCA was assessed by Bland–Altman analysis. Postoperative complications were classified according to Clavien–Dindo. Statistical significance was defined as p < .05. Results EC data was available in 64% of monitoring time (with SQI > 70 in 90% of recorded data). Bland–Altman analysis showed a bias of + 0.24 L/min/m² (95% CI 0.23–0.25 L/min/m ² ; limits of agreement − 1.39 to + 1.87 L/min/m²), and percentage error of 54%. Hemodynamic risk patterns (hypotension, low CI, vasoplegia) were not significantly associated with postoperative complications. In contrast, male sex (OR 9.0, 95% CI 1.74–46.59), misuse of nicotine (OR 4.81, 95% CI 1.27–18.31), and antihypertensive therapy (OR 5.4; 95% CI 1.27–23.05) were significantly linked to adverse outcomes, including pneumonia, delirium, and organ dysfunction. Conclusion EC and PCA are not interchangeable for absolute CI-measurement. While EC may detect perioperative trends, patient-related factors proved to be stronger predictors of postoperative complications than the hemodynamic markers assessed.