Radial-to-femoral pressure gradient quantification in cardiac surgery
Vincent Bouchard-Dechêne, Loay Kontar, Pierre Couture, Philippe Pérusse, Sylvie Lévesque, Yoan Lamarche, André Denault, Antoine Rochon, Alain Deschamps, Georges Desjardins, Nicolas Rousseau‐Saine, Jean-Sébastien Lebon, Jennifer Cogan, Marie-Ève Chamberland, Meggie Raymond, Athanase Courbe, Marco Julien, Christian Ayoub, Maria Rosal Martins, William Beaubien–Souligny
Abstract
Background: A radial-to-femoral pressure gradient (RFPG) can occur in roughly one-third of cardiac surgical patients. Such a gradient has been associated with smaller stature and potentially smaller radial artery diameter. We hypothesized that preoperative radial artery diameter could be a predictor of RFPG. We also investigated the clinical impact of using a femoral versus a radial arterial catheter in terms of vasoactive support. Methods: Using ultrasound, we measured the bilateral radial artery diameters of 160 cardiac surgical patients. All arterial pressure values were continuously recorded. Significant RFPG was defined as ≥25 mm Hg in systolic and/or ≥10 mm Hg in mean arterial pressure. One hundred and forty-nine additional patients were used to validate the impact of our observations. Results: = .016) despite undergoing shorter and less complex procedures. In the validation cohort, similar observations were made, and patients with a radial artery catheter received a longer duration of vasoactive support in the intensive care unit. Conclusions: A significant RFPG occurs in one-third of cardiac surgical patients and in 48% of those with a radial artery diameter <1.8 mm. The use of a single radial arterial catheter instead of dual radial and femoral catheters was associated with greater vasopressor requirements in the operating room and in the intensive care unit. We do not recommend the use of a single radial artery catheter in cardiac surgery.