Newly Published
Perioperative Medicine  |   July 2020
Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery
Author Notes
  • From the Department of Anesthesiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany (J.B., P.C., L.F., A.S.M., M.T.); the Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany (T.B., A.D., A.H.); the Department of Anesthesiology, RoMed Klinikum, Rosenheim, Germany (A.K., G.P., A.B.); and Philips Medizin Systeme Boeblingen GmbH, Germany (U.J.P.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication March 19, 2020. Accepted for publication June 19, 2020.
    Submitted for publication March 19, 2020. Accepted for publication June 19, 2020.×
  • Correspondence: Address correspondence to Dr. Briegel: Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität, Marchioninistrasse 15, DE 81377 München, Germany. josef.briegel@med.lmu.de. Anesthesiology’s articles are made freely accessible to all readers on www.anesthesiology.org, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia
Perioperative Medicine   |   July 2020
Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery
Anesthesiology Newly Published on July 23, 2020. doi:https://doi.org/10.1097/ALN.0000000000003472
Anesthesiology Newly Published on July 23, 2020. doi:https://doi.org/10.1097/ALN.0000000000003472
Abstract

Background: In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure.

Methods: Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery.

Results: 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements.

Conclusions: The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery.

Editor’s Perspective:

What We Already Know about This Topic:

  • Oscillometric blood pressure assessments are routine in surgical patients and most clinical environments but are considerably less accurate than generally appreciated

What This Article Tells Us That Is New:

  • A novel noninvasive upper arm system using hydraulic coupling technology provides accurate and precise estimates of the systolic, mean, and diastolic pressure compared with direct measurements of the femoral arteries