Inaccuracy of radial artery pressure measurement after cardiac operations

The phenomenon of a pressure gradient between central and radial arteries was evaluated in 48 patients immediately after coronary artery bypass operations. All were in stable hemodynamic condition, none receiving catecholamine support. In eight patients (Group A) mean femoral pressure was significantly higher than mean radial pressure (range 10 to 30 mm Hg). In the remaining 40 (Group B) radial and femoral pressures were equal. Mean cardiac index (thermodilution) was 3.3 ± 0.68 versus 2.1 ± 0.4 L/min/m², systemic vascular resistance 1,181 ± 218.4 versus 2,049 ± 501 dynes/sec/cm^-5, toe temperature 23.8° ± 1.2° C versus 24.02° ± 0.9° C, core temperature 33.9° ± 0.5° C versus 34.1° ± 0.6° C, mixed venous oxygen saturation 78% ± 3% versus 62% ± 5%, and peak radial dP/dt 1,485 ± 366 versus 2,028 ± 392 in Groups A and B, respectively. These data indicate, first, that the low radial pressures measured in Group A patients did not represent the true aortic pressures; that is, they were false. Second, these low pressures had nothing to do with compromised cardiac function; rather, they were due to peripheral constriction and volume factors and also probably to proximal shunting. It is therefore recommended that while the chest is still open, if a discrepancy exists between a low radial artery pressure, a high palpable aortic pressure, and a satisfactory cardiac contraction, a femoral cannula for pressure measurement should be inserted. Treatment is by blood infusion until the femoral-radial gradient has been abolished.