Introduction .– Cardiac output (CO) monitoring is important during pediatric congenital cardiopathy surgery. Doppler transesophageal echocardiography (TEE) remains the most valuable technique in perioperative settings. Pressure recording analytical method (PRAM) uses arterial pressure waveform analysis to continuously measure CO. This minimally invasive hemodynamic method was assessed in pediatric intensive care unit but showed controversial results depending on the range of body surface area (BSA). The relevance of the method and the pediatric algorithm remains to be assessed in the perioperative setting.

Objectives .– We assessed agreement of PRAM method and TEE in measuring perioperative cardiac output during cardiac congenital surgery in children.

Methods .– Observational, prospective and single center study. Thirty-six children (median [25th–75th percentiles]): sex ratio 14 m/22 f, age 6 years [4 months–15 years]; body surface area (BSA) 0.74 m ² [0.50–1.11]) were included. Three to seven measures were simultaneous realized: TEE (aortic diameter followed by transaortic valve continuous wave-Doppler signal via transgastric view) and PRAM pediatric algorithm after sternal closure. Linear correlations, Bland–Altman analysis and percentage of error (Critchley-Critchley) were performed according to BSA (mix and BSA < 1.10 m ² ).

Results .– One hundred and seventy-three paired measurements were compared. The mean CO (SD) was 2.5(1.4) l/min with TEE-CO and 2.3(1.4) l/min with PRAM-CO. The mean bias was 0.2 l/min with agreements limits –2.4 and 2.8 l/min. Pearson’s correlation was 0.29 giving a percentage error of 108%. In the group with median BSA < 1.10 m ² ( n = 26, 131 measures), mean CO was 1.9 (0.7) l/min with TEE-CO and 1.8(0.6) l/min with PRAM-CO. The mean bias was 0.03 l/min with agreements limits –1.06 and 1.13 l/min. Pearson’s correlation was 0.64 giving a percentage error of 60%.

Conclusions .– Differences between PRAM and TEE were significant at all ages and BSA. These results do not support the use of the Mostcare ^® monitor to evaluate CO in the setting of pediatric cardiac surgery.