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Chapter 10 - Noninvasive Measurement of Cardiac Output

Published online by Cambridge University Press:  28 April 2020

By
Samuel Gilliland ,
Robert H. Thiele  and
Karsten Bartels
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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Summary

Since the combination of thermodilution with the balloon-tipped pulmonary arterial catheter by Swan and Ganz in the 1970s, researchers and clinicians have pursued the measurement and optimization of cardiac output to improve outcomes both in the operating room and the intensive care unit. Complications related to the invasiveness of this device have driven exploration of new methods to acquire the same information without the deleterious side effects, with mixed results. We will discuss several of these devices, the physical principles underlying their measurements, their relative accuracy compared to clinical and experimental standards, and clinical advantages and disadvantages of each device.

Keywords

Noninvasive cardiac outputthermodilutionbioimpedancebioreactancepulse contour analysisphotoplethysmographyultrasound-based
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 100 - 108
Publisher: Cambridge University Press
Print publication year: 2020

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References

Geerts, BF, Aarts, LP, Jansen, JR. Methods in pharmacology: measurement of cardiac output. Br J Clin Pharmacol 2011;71(3):316–30.CrossRefGoogle ScholarPubMed
Ganz, W, Donoso, R, Marcus, HS, Forrester, JS, Swan, HJ. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol 1971;27(4):392–6.Google Scholar
Swan, HJ, Ganz, W, Forrester, J, et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970;283(9):447–51.Google Scholar
Fegler, G. Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q J Exp Physiol Cogn Med Sci 1954;39(3):153–64.Google ScholarPubMed
Sandham, JD, Hull, RD, Brant, RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003;348(1):5–14.Google Scholar
Richard, C, Warszawski, J, Anguel, N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2003;290(20):2713–20.Google Scholar
Harvey, S, Harrison, DA, Singer, M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet 2005;366(9484):472–7.CrossRefGoogle ScholarPubMed
Porhomayon, J, El-Solh, A, Papadakos, P, Nader, ND. Cardiac output monitoring devices: an analytic review. Intern Emerg Med 2012;7(2):163–71.Google Scholar
Stewart, G. The output of the heart in dogs. Am J Physiol 1921;57:27–50.Google Scholar
Profant, M VK, Eckhardt, U. The Stewart-Hamilton equations and the indicator dilution method. SIAM J Appl Math 1978;34:666–75.CrossRefGoogle Scholar
Nishikawa, T, Dohi, S. Errors in the measurement of cardiac output by thermodilution. Can J Anaesth 1993;40(2):142–53.CrossRefGoogle ScholarPubMed
Cigarroa, RG, Lange, RA, Williams, RH, Bedotto, JB, Hillis, LD. Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. Am J Med 1989;86(4):417–20.Google Scholar
Maruschak, GF, Potter, AM, Schauble, JF, Rogers, MC. Overestimation of pediatric cardiac output by thermal indicator loss. Circulation 1982;65(2):380–3.Google Scholar
van Grondelle, A, Ditchey, RV, Groves, BM, Wagner, WW Jr, Reeves, JT. Thermodilution method overestimates low cardiac output in humans. Am J Physiol 1983;245(4):H690–2.Google Scholar
Bazaral, MG, Petre, J, Novoa, R. Errors in thermodilution cardiac output measurements caused by rapid pulmonary artery temperature decreases after cardiopulmonary bypass. Anesthesiology 1992;77(1):31–7.CrossRefGoogle ScholarPubMed
Latson, TW, Whitten, CW, O’Flaherty, D. Ventilation, thermal noise, and errors in cardiac output measurements after cardiopulmonary bypass. Anesthesiology 1993;79(6):1233–43.Google Scholar
Yang, XX, Critchley, LA, Joynt, GM. Determination of the precision error of the pulmonary artery thermodilution catheter using an in vitro continuous flow test rig. Anesth Analg 2011;112(1):70–7.CrossRefGoogle Scholar
Philip, JH, Long, MC, Quinn, MD, Newbower, RS. Continuous thermal measurement of cardiac output. IEEE Trans Biomed Eng 1984;31(5):393–400.Google Scholar
Aranda, M, Mihm, FG, Garrett, S, Mihm, MN, Pearl, RG. Continuous cardiac output catheters: delay in in vitro response time after controlled flow changes. Anesthesiology 1998;89(6):1592–5.Google Scholar
Goldstein, LJ. Response time of the Opti-Q continuous cardiac output pulmonary artery catheter in the urgent mode to a step change in cardiac output. J Clin Monit Comput 1999;15(7–8):435–9.CrossRefGoogle ScholarPubMed
Iberti, TJ, Fischer, EP, Leibowitz, AB, et al. A multicenter study of physicians’ knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group. JAMA 1990;264(22):2928–32.Google Scholar
Schuster, AH, Nanda, NC. Doppler echocardiographic measurement of cardiac output: comparison with a non-golden standard. Am J Cardiol. 1984;53(1):257–9.Google Scholar
Smith, HJ, Grottum, P, Simonsen, S. Doppler flowmetry in the lower thoracic aorta. An indirect estimation of cardiac output. Acta Radiol Diagn (Stockh) 1985;26(3):257–63.Google ScholarPubMed
Davies, JN, Allen, DR, Chant, AD. Non-invasive Doppler-derived cardiac output: a validation study comparing this technique with thermodilution and Fick methods. Eur J Vasc Surg. 1991;5(5):497–500.CrossRefGoogle ScholarPubMed
Valtier, B, Cholley, BP, Belot, JP, et al. Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler. Am J Respir Crit Care Med 1998;158(1):77–83.CrossRefGoogle ScholarPubMed
Lowe, GC, BM; Philpot, EJ, et al. Oesophageal Doppler Monitor (ODM) guided individualised goal directed fluid management (iGDFM) in surgery – a technical review. Deltex Medical Technical Review; 2010.Google Scholar
Kouchoukos, NT, Sheppard, LC, McDonald, DA. Estimation of stroke volume in the dog by a pulse contour method. Circ Res 1970;26(5):611–23.CrossRefGoogle ScholarPubMed
Essler, S, Schroeder, MJ, Phaniraj, V, et al. Fast estimation of arterial vascular parameters for transient and steady beats with application to hemodynamic state under variant gravitational conditions. Ann Biomed Eng 1999;27(4):486–97.Google Scholar
Wesseling, K, de Witt, B, Weber, A. A simple device for the continuous measurement of cardiac output. Adv Cardiovasc Phys 1983;5:16–52.Google Scholar
Bajorat, J, Hofmockel, R, Vagts, DA, et al. Comparison of invasive and less-invasive techniques of cardiac output measurement under different haemodynamic conditions in a pig model. Eur J Anaesthesiol 2006;23(1):23–30.Google Scholar
Marx, G, Schuerholz, T, Sumpelmann, R, Simon, T, Leuwer, M. Comparison of cardiac output measurements by arterial trans-cardiopulmonary and pulmonary arterial thermodilution with direct Fick in septic shock. Eur J Anaesthesiol 2005;22(2):129–34.Google Scholar
Pauli, C, Fakler, U, Genz, T, et al. Cardiac output determination in children: equivalence of the transpulmonary thermodilution method to the direct Fick principle. Intensive Care Med 2002;28(7):947–52.Google Scholar
Goedje, O, Hoeke, K, Lichtwarck-Aschoff, M, et al. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 1999;27(11):2407–12.Google Scholar
Sakka, SG, Kozieras, J, Thuemer, O, van Hout, N. Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth 2007;99(3):337–42.CrossRefGoogle ScholarPubMed
Della Rocca, G, Costa, MG, Pompei, L, Coccia, C, Pietropaoli, P. Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique. Br J Anaesth 2002;88(3):350–6.Google Scholar
Hamzaoui, O, Monnet, X, Richard, C, et al. Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period. Crit Care Med 2008;36(2):434–40.Google Scholar
Buhre, W, Weyland, A, Kazmaier, S, et al. Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting. J Cardiothorac Vasc Anesth 1999;13(4):437–40.Google Scholar
Gust, R, Gottschalk, A, Bauer, H, et al. Cardiac output measurement by transpulmonary versus conventional thermodilution technique in intensive care patients after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 1998;12(5):519–22.Google Scholar
Linton, NW, Linton, RA. Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. Br J Anaesth 2001;86(4):486–96.CrossRefGoogle ScholarPubMed
Linton, RA, Young, LE, Marlin, DJ, et al. Cardiac output measured by lithium dilution, thermodilution, and transesophageal Doppler echocardiography in anesthetized horses. Am J Vet Res 2000;61(7):731–7.Google Scholar
Kurita, T, Morita, K, Kato, S, et al. Lithium dilution cardiac output measurements using a peripheral injection site comparison with central injection technique and thermodilution. J Clin Monit Comput 1999;15(5):279–85.Google Scholar
Kurita, T, Morita, K, Kato, S, et al. Comparison of the accuracy of the lithium dilution technique with the thermodilution technique for measurement of cardiac output. Br J Anaesth 1997;79(6):770–5.Google Scholar
Linton, RA, Band, DM, Haire, KM. A new method of measuring cardiac output in man using lithium dilution. Br J Anaesth 1993;71(2):262–6.Google Scholar
Costa, MG, Della Rocca, G, Chiarandini, P, et al. Continuous and intermittent cardiac output measurement in hyperdynamic conditions: pulmonary artery catheter vs. lithium dilution technique. Intensive Care Med 2008;34(2):257–63.Google Scholar
Mora, B, Ince, I, Birkenberg, B, et al. Validation of cardiac output measurement with the LiDCO pulse contour system in patients with impaired left ventricular function after cardiac surgery. Anaesthesia 2011;66(8):675–81.Google Scholar
Pratt, B, Roteliuk, L, Hatib, F, Frazier, J, Wallen, RD. Calculating arterial pressure-based cardiac output using a novel measurement and analysis method. Biomed Instrum Technol 2007;41(5):403–11.Google Scholar
Marque, S, Cariou, A, Chiche, JD, Squara, P. Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring. Crit Care 2009;13(3):R73.Google Scholar
Opdam, HI, Wan, L, Bellomo, R. A pilot assessment of the FloTrac cardiac output monitoring system. Intensive Care Med 2007;33(2):344–9.Google Scholar
Cannesson, M, Attof, Y, Rosamel, P, et al. Comparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements. Eur J Anaesthesiol 2007;24(10):832–9.Google Scholar
Breukers, RM, Sepehrkhouy, S, Spiegelenberg, SR, Groeneveld, AB. Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery. J Cardiothorac Vasc Anesth 2007;21(5):632–5.Google Scholar
Biais, M, Nouette-Gaulain, K, Cottenceau, V, et al. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg 2008;106(5):1480–6.Google Scholar
Biancofiore, G, Critchley, LA, Lee, A, et al. Evaluation of a new software version of the FloTrac/Vigileo (version 3.02) and a comparison with previous data in cirrhotic patients undergoing liver transplant surgery. Anesth Analg 2011;113(3):515–22.CrossRefGoogle Scholar
Saraceni, E, Rossi, S, Persona, P, et al. Comparison of two methods for cardiac output measurement in critically ill patients. Br J Anaesth 2011;106(5):690–4.Google Scholar
Eleftheriadis, S, Galatoudis, Z, Didilis, V, et al. Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo-derived cardiac output measurements: a prospective comparison study. Crit Care 2009;13(6):R179.Google Scholar
Sander, M, Spies, CD, Grubitzsch, H, et al. Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements. Crit Care 2006;10(6):R164.Google Scholar
Romano, SM, Pistolesi, M. Assessment of cardiac output from systemic arterial pressure in humans. Crit Care Med 2002;30(8):1834–41.CrossRefGoogle ScholarPubMed
Romagnoli, S, Romano, SM, Bevilacqua, S, et al. Cardiac output by arterial pulse contour: reliability under hemodynamic derangements. Interact Cardiovasc Thorac Surg 2009;8(6):642–6.Google Scholar
Franchi, F, Silvestri, R, Cubattoli, L, et al. Comparison between an uncalibrated pulse contour method and thermodilution technique for cardiac output estimation in septic patients. Br J Anaesth 2011;107(2):202–8.Google Scholar
Scolletta, S, Franchi, F, Taccone, FS, et al. An uncalibrated pulse contour method to measure cardiac output during aortic counterpulsation. Anesth Analg 2011;113(6):1389–95.Google Scholar
Hadian, M, Kim, HK, Severyn, DA, Pinsky, MR. Cross-comparison of cardiac output trending accuracy of LiDCO, PiCCO, FloTrac and pulmonary artery catheters. Crit Care 2010;14(6):R212.Google Scholar
Krejci, V, Vannucci, A, Abbas, A, Chapman, W, Kangrga, IM. Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation. Liver Transpl 2010;16(6):773–82.Google Scholar
Johansson, A, Chew, M. Reliability of continuous pulse contour cardiac output measurement during hemodynamic instability. J Clin Monit Comput 2007;21(4):237–42.Google Scholar
Bein, B, Meybohm, P, Cavus, E, et al. The reliability of pulse contour-derived cardiac output during hemorrhage and after vasopressor administration. Anesth Analg 2007;105(1):107–13.Google Scholar
Zollner, C, Haller, M, Weis, M, et al. Beat-to-beat measurement of cardiac output by intravascular pulse contour analysis: a prospective criterion standard study in patients after cardiac surgery. J Cardiothorac Vasc Anesth 2000;14(2):125–9.Google Scholar
O’Rourke, MF, Yaginuma, T, Avolio, AP. Physiological and pathophysiological implications of ventricular/vascular coupling. Ann Biomed Eng 1984;12(2):119–34.Google Scholar
O’Rourke, MF. Pressure and flow waves in systemic arteries and the anatomical design of the arterial system. J Appl Physiol 1967;23(2):139–49.Google Scholar
Wisely, NA, Cook, LB. Arterial flow waveforms from pulse oximetry compared with measured Doppler flow waveforms apparatus. Anaesthesia 2001;56(6):556–61.Google Scholar
Millasseau, SC, Guigui, FG, Kelly, RP, et al. Noninvasive assessment of the digital volume pulse: comparison with the peripheral pressure pulse. Hypertension 2000;36(6):952–6.Google Scholar
Almond, NE, Jones, DP, Cooke, ED. Noninvasive measurement of the human peripheral circulation: relationship between laser Doppler flowmeter and photoplethysmograph signals from the finger. Angiology 1988;39(9):819–29.CrossRefGoogle ScholarPubMed
Natalini, G, Rosano, A, Taranto, M, et al. Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesth Analg 2006;103(6):1478–84.Google Scholar
Cannesson, M, Besnard, C, Durand, PG, Bohe, J, Jacques, D. Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients. Crit Care 2005;9(5):R562–8.Google Scholar
Cannesson, M, Attof, Y, Rosamel, P, et al. Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room. Anesthesiology 2007;106(6):1105–11.Google Scholar
Chan, GS, Middleton, PM, Celler, BG, Wang, L, Lovell, NH. Automatic detection of left ventricular ejection time from a finger photoplethysmographic pulse oximetry waveform: comparison with Doppler aortic measurement. Physiol Meas 2007;28(4):439–52.Google Scholar
Geeraerts, T, Albaladejo, P, Declere, AD, et al. Decrease in left ventricular ejection time on digital arterial waveform during simulated hypovolemia in normal humans. J Trauma 2004;56(4):845–9.Google Scholar
Bendjelid, K, Suter, PM, Romand, JA. The respiratory change in preejection period: a new method to predict fluid responsiveness. J Appl Physiol (1985) 2004;96(1):337–42.Google Scholar
Feissel, M, Badie, J, Merlani, PG, Faller, JP, Bendjelid, K. Pre-ejection period variations predict the fluid responsiveness of septic ventilated patients. Crit Care Med 2005;33(11):2534–9.Google Scholar
Chowienczyk, PJ, Kelly, RP, MacCallum, H, et al. Photoplethysmographic assessment of pulse wave reflection: blunted response to endothelium-dependent beta2-adrenergic vasodilation in type II diabetes mellitus. J Am Coll Cardiol 1999;34(7):2007–14.Google Scholar
Murray, WB, Foster, PA. The peripheral pulse wave: information overlooked. J Clin Monit 1996;12(5):365–77.Google Scholar
Lund, F. Digital pulse plethysmography (DPG) in studies of the hemodynamic response to nitrates–a survey of recording methods and principles of analysis. Acta Pharmacol Toxicol (Copenh) 1986;59 Suppl 6:79–96.Google Scholar
Ezri, T, Steinmetz, A, Geva, D, Szmuk, P. Skin vasomotor reflex as a measure of depth of anesthesia. Anesthesiology 1998;89(5):1281–2.Google Scholar
Zhang, XY, Zhang, YT. The effect of local mild cold exposure on pulse transit time. Physiol Meas 2006;27(7):649–60.Google Scholar
Awad, AA, Ghobashy, MA, Ouda, W, et al. Different responses of ear and finger pulse oximeter wave form to cold pressor test. Anesth Analg 2001;92(6):1483–6.Google Scholar
Awad, AA, Haddadin, AS, Tantawy, H, et al. The relationship between the photoplethysmographic waveform and systemic vascular resistance. J Clin Monit Comput 2007;21(6):365–72.Google Scholar
Lee, QY, Chan, GS, Redmond, SJ, et al. Multivariate classification of systemic vascular resistance using photoplethysmography. Physiol Meas 2011;32(8):1117–32.Google Scholar
Lax, H, Feinberg, AW, Cohen, BM. Studies of the arterial pulse wave: I. The normal pulse wave and its modification in the presence of human arteriosclerosis. J Chronic Dis 1956;3(6):618–31.Google Scholar
Dawber, TR, Thomas, HE, Jr., McNamara, PM. Characteristics of the dicrotic notch of the arterial pulse wave in coronary heart disease. Angiology 1973;24(4):244–55.Google Scholar
Millasseau, SC, Kelly, RP, Ritter, JM, Chowienczyk, PJ. Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clin Sci (Lond) 2002;103(4):371–7.CrossRefGoogle ScholarPubMed
Arnett, DK, Evans, GW, Riley, WA. Arterial stiffness: a new cardiovascular risk factor? Am J Epidemiol 1994;140(8):669–82.Google Scholar
Keren, H, Burkhoff, D, Squara, P. Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance. Am J Physiol Heart Circ Physiol 2007;293(1):H583-9.Google Scholar
Raval, NY, Squara, P, Cleman, M, et al. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput 2008;22(2):113–9.Google Scholar
Weisz, DE, Jain, A, McNamara, PJ, EL-K, A. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography. Neonatology 2012;102(1):61–7.Google Scholar
Thiele, RH, Bartels, K, Gan, TJ. Cardiac output monitoring: a contemporary assessment and review. Crit Care Med 2015;43(1):177–85.Google Scholar

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