Although cardiac output (CO) monitoring is usually only used in intensive care units (ICUs) and operating rooms, there is increasing evidence that CO should be determined and optimized as early as possible, even before admission to the ICU, in the care of hemodynamically compromised patients. A variety of different minimally or noninvasive CO determination techniques have been developed, but not all of them are suitable for early hemodynamic monitoring outside the ICU. In this review, the different available methods for CO monitoring are presented and their potential for early hemodynamic assessment is discussed.
Connors AFJr , Speroff T., Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276:889-897.
6.
Ivanov R., Allen J., Calvin JEThe incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: a meta-analysis. Crit Care Med. 2000;28:615-619.
7.
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: 5-14.
8.
Taylor RW Jr, Calvin JE, Matuschak GMPulmonary Artery Catheter Consensus Conference: the first step. Crit Care Med. 1997;25:2064-2065.
9.
Cholley BP, Payen D.Noninvasive techniques for measurements of cardiac output. Curr Opin Crit Care. 2005;11:424-429.
10.
Hofer CK, Ganter MT, Zollinger A.What technique should I use to measure cardiac output? Curr Opin Crit Care. 2007;13:308-317.
11.
Mathews L., Singh RKCardiac output monitoring. Ann Card Anaesth. 2008;11:56-68.
Reuter DA, Goetz AEMeasurement of cardiac output [in German]. Anaesthesist . 2005;54:1135-1151.
14.
Ganz W., Donoso R., Marcus HS, Forrester JS, Swan HJA new technique for measurement of cardiac output by thermodilution in man . Am J Cardiol. 1971;27:392-396.
15.
Branthwaite MA, Bradley RDMeasurement of cardiac output by thermal dilution in man. J Appl Physiol. 1968 ;24:434-438.
16.
Fegler G.Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q J Exp Physiol Cogn Med Sci. 1954 ;39:153-164.
17.
Hamilton W. , Moore J., Kinsman J., Spurling R.Simultaneous determination of the greater and lesser circulation time, of the mean velocity of blood flow through the heart and lungs, of the cardiac output and an approximation of the amount of blood actively circulating in the heart and lungs. Am J Physiol. 1928;85:377-378.
18.
Nishikawa T. , Dohi S.Errors in the measurement of cardiac output by thermodilution. Can J Anaesth. 1993;40: 142-153.
19.
Leather HA, Vuylsteke A., Bert C., et al. Evaluation of a new continuous cardiac output monitor in off-pump coronary artery surgery. Anaesthesia. 2004 ;59:385-389.
von Spiegel T. , Wietasch G., Bürsch J., Hoeft A.Cardiac output determination with transpulmonary thermodilution. An alternative to pulmonary catheterization? [in German]. Anaesthesist. 1996;45:1045-1050.
22.
Della Rocca G. , Costa MG, Coccia C., et al. Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation . Can J Anaesth. 2003;50:707-711.
23.
Gust R., Gottschalk A., Bauer H., Bottiger BW, Bohrer H., Martin E.Cardiac output measurement by transpulmonary versus conventional thermodilution technique in intensive care patients after coronary artery bypass grafting . J Cardiothorac Vasc Anesth. 1998;12:519-522.
24.
Holm C., Melcer B., Horbrand F., Henckel von Donnersmarck G., Muhlbauer W.Arterial thermodilution: an alternative to pulmonary artery catheter for cardiac output assessment in burn patients. Burns. 2001;27:161-166.
25.
Sakka SG, Reinhart K., Meier-Hellmann A.Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med. 1999;25:843-846.
26.
Sakka SG, Bredle DL, Reinhart K., Meier-Hellmann A.Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock. J Crit Care. 1999;14:78-83.
27.
Kumar A., Anel R., Bunnell E., et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32:691-699.
28.
Garcia-Rodriguez C., Pittman J., Cassell CH, et al. Lithium dilution cardiac output measurement: a clinical assessment of central venous and peripheral venous indicator injection . Crit Care Med. 2002;30:2199-2204.
29.
Linton RA, Band DM, Haire KMA new method of measuring cardiac output in man using lithium dilution . Br J Anaesth. 1993;71:262-266.
30.
Pearse R., Dawson D., Fawcett J., Rhodes A., Grounds RM, Bennett EDEarly goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445] . Crit Care. 2005;9:R687-R693.
31.
Kurita T., Morita K., Kato S., Kikura M., Horie M., Ikeda K.Comparison of the accuracy of the lithium dilution technique with the thermodilution technique for measurement of cardiac output. Br J Anaesth . 1997;79:770-775.
32.
Linton R., Band D., O'Brien T., Jonas M., Leach R.Lithium dilution cardiac output measurement: a comparison with thermodilution . Crit Care Med. 1997;25:1796-1800.
33.
Hofer CK, Buhlmann S., Klaghofer R., Genoni M., Zollinger A.Pulsed dye densitometry with two different sensor types for cardiac output measurement after cardiac surgery: a comparison with the thermodilution technique . Acta Anaesthesiol Scand. 2004;48:653-657.
34.
Kroon M., Groeneveld AB, Smulders YMCardiac output measurement by pulse dye densitometry: comparison with pulmonary artery thermodilution in post-cardiac surgery patients. J Clin Monit Comput. 2005;19: 395-399.
35.
Bremer F., Schiele A., Tschaikowsky K.Cardiac output measurement by pulse dye densitometry: a comparison with the Fick's principle and thermodilution method. Intensive Care Med. 2002;28:399-405.
36.
Baulig W., Bernhard EO, Bettex D., Schmidlin D., Schmid ERCardiac output measurement by pulse dye densitometry in cardiac surgery . Anaesthesia. 2005;60: 968-973.
37.
Maarek JM, Holschneider DP, Yang J., Pniak SN, Rubinstein EHTranscutaneous fluorescence dilution cardiac output and circulating blood volume during hemorrhagic hypovolemia. Anesthesiology . 2005;102: 774-782.
38.
Sakka SG, Reinhart K., Wegscheider K., Meier-Hellmann A.Comparison of cardiac output and circulatory blood volumes by transpulmonary thermo-dye dilution and transcutaneous indocyanine green measurement in critically ill patients. Chest. 2002;121:559-565.
39.
Fick A.Über die Messung des Blutquantums in den Herzventrikeln. Sitzungsber Physiol-Med Gesell Würzburg. 1870;2:16.
40.
Jaffe MBPartial CO2 rebreathing cardiac output- operating principles of the NICO system . J Clin Monit Comput. 1999;15:387-401.
41.
Jover JL, Soro M., Belda FJ, Aguilar G., Caro P., Ferrandis R.Measurement of cardiac output after cardiac surgery: validation of a partial carbon dioxide rebreathing (NICO) system in comparison with continuous thermodilution with a pulmonary artery catheter [in Spanish]. Rev Esp Anestesiol Reanim. 2005;52:256-262.
42.
Nilsson LB, Eldrup N., Berthelsen PGLack of agreement between thermodilution and carbon dioxide-rebreathing cardiac output. Acta Anaesthesiol Scand. 2001 ;45:680-685.
43.
van Heerden PV, Baker S., Lim SI, Weidman C., Bulsara M.Clinical evaluation of the non-invasive cardiac output (NICO) monitor in the intensive care unit . Anaesth Intensive Care. 2000;28:427-430.
44.
Lavandier B. , Cathignol D., Muchada R., Xuan BB, Motin J.Noninvasive aortic blood flow measurement using an intraesophageal probe. Ultrasound Med Biol. 1985;11: 451-460.
45.
Berton C., Cholley B.Equipment review: new techniques for cardiac output measurement-oesophageal Doppler, Fick principle using carbon dioxide, and pulse contour analysis. Crit Care. 2002;6:216-221.
46.
Lefrant JY, Bruelle P., Aya AG, et al. Training is required to improve the reliability of esophageal Doppler to measure cardiac output in critically ill patients. Intensive Care Med. 1998;24:347-352.
47.
Dark PM, Singer M.The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults. Intensive Care Med. 2004;30: 2060-2066.
48.
Raaijmakers E. , Faes TJ, Scholten RJ, Goovaerts HG, Heethaar RMA meta-analysis of published studies concerning the validity of thoracic impedance cardiography . Ann N Y Acad Sci. 1999;873:121-127.
49.
de Wilde RB, Schreuder JJ, van den Berg PC, Jansen JRAn evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery. Anaesthesia. 2007;62:760-768.
50.
Jansen JR, Wesseling KH, Settels JJ, Schreuder JJContinuous cardiac output monitoring by pulse contour during cardiac surgery . Eur Heart J.1990;11(suppl I):26-32.
51.
Gödje O., Höke K., Goetz AE, et al. Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med. 2002;30:52-58.
52.
Gödje O., Höke K., Lamm P., et al. Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac Cardiovasc Surg. 1998;46:242-249.
53.
Bein B., Worthmann F., Tonner PH, et al. Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output. J Cardiothorac Vasc Anesth. 2004;18:185-189.
54.
Felbinger TW , Reuter DA, Eltzschig HK, Moerstedt K., Goedje O., Goetz AEComparison of pulmonary arterial thermodilution and arterial pulse contour analysis: evaluation of a new algorithm. J Clin Anesth. 2002;14:296-301.
55.
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: 350-356.
56.
Chaney JC, Derdak S.Minimally invasive hemodynamic monitoring for the intensivist: current and emerging technology. Crit Care Med. 2002 ;30:2338-2345.
57.
Halvorsen PS , Espinoza A., Lundblad R., et al. Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery. Acta Anaesthesiol Scand. 2006;50:1050-1057.
58.
Jansen JR, Schreuder JJ, Mulier JP, Smith NT, Settels JJ, Wesseling KHA comparison of cardiac output derived from the arterial pressure wave against thermodilution in cardiac surgery patients. Br J Anaesth. 2001;87:212-222.
59.
Wesseling KH , Jansen JR, Settels JJ, Schreuder JJComputation of aortic flow from pressure in humans using a nonlinear, three-element model . J Appl Physiol . 1993;74:2566-2573.
60.
Bogert LW, van Lieshout JJNon-invasive pulsatile arterial pressure and stroke volume changes from the human finger. Exp Physiol. 2005;90:437-446.
61.
Gerhardt UM , Scholler C., Bocker D., Hohage H.Noninvasive estimation of cardiac output in critical care patients. J Clin Monit Comput. 2000;16:263-268.
62.
Hirschl MM, Binder M., Gwechenberger M., et al. Noninvasive assessment of cardiac output in critically ill patients by analysis of the finger blood pressure waveform. Crit Care Med. 1997;25:1909-1914.
63.
Hirschl MM, Kittler H., Woisetschlager C., et al. Simultaneous comparison of thoracic bioimpedance and arterial pulse waveform-derived cardiac output with thermodilution measurement. Crit Care Med. 2000;28: 1798-1802.
64.
Jellema WT, Wesseling KH, Groeneveld AB, Stoutenbeek CP, Thijs LG, van Lieshout JJContinuous cardiac output in septic shock by simulating a model of the aortic input impedance: a comparison with bolus injection thermodilution . Anesthesiology. 1999;90:1317-1328.
65.
Jonas MM, Tanser SJLithium dilution measurement of cardiac output and arterial pulse waveform analysis: an indicator dilution calibrated beat-by-beat system for continuous estimation of cardiac output. Curr Opin Crit Care . 2002;8:257-261.
66.
Linton NW, Linton RAEstimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. Br J Anaesth. 2001;86:486-496.
67.
Cecconi M., Fawcett J., Grounds RM, Rhodes A.A prospective study to evaluate the accuracy of pulse power analysis to monitor cardiac output in critically ill patients. BMC Anesthesiol . 2008;8:3.
68.
Hamilton TT , Huber LM, Jessen MEPulseCO: a less-invasive method to monitor cardiac output from arterial pressure after cardiac surgery . Ann Thorac Surg. 2002;74:S1408-S1412.
69.
Missant C., Rex S., Wouters PFAccuracy of cardiac output measurements with pulse contour analysis (PulseCO) and Doppler echocardiography during off-pump coronary artery bypass grafting . Eur J Anaesthesiol. 2008;25:243-248.
70.
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;106:1480-1486.
71.
de Waal EE, Kalkman CJ, Rex S., Buhre WFValidation of a new arterial pulse contour-based cardiac output device . Crit Care Med. 2007;35:1904-1909.
72.
Breukers RM , Sepehrkhouy S., Spiegelenberg SR, Groeneveld ABCardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery. J Cardiothorac Vasc Anesth. 2007;21:632-635.
73.
Button D., Weibel L., Reuthebuch O., Genoni M., Zollinger A., Hofer CKClinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth. 2007;99:329-336.
74.
Cannesson M. , Attof Y., Rosamel P., Joseph P., Bastien O., Lehot JJComparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements . Eur J Anaesthesiol. 2007;24:832-839.
75.
Compton FD, Zukunft B., Hoffmann C., Zidek W., Schaefer JHPerformance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac/Vigileo) in haemodynamically unstable patients. Br J Anaesth. 2008;100: 451-456.
76.
Lorsomradee S., Lorsomradee SR, Cromheecke S., De Hert SGContinuous cardiac output measurement: arterial pressure analysis versus thermodilution technique during cardiac surgery with cardiopulmonary bypass. Anaesthesia . 2007;62:979-983.
77.
Manecke GR, Jr., Auger WRCardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. J Cardiothorac Vasc Anesth. 2007 ;21:3-7.
78.
Mayer J., Boldt J., Schollhorn T., Rohm KD, Mengistu AM, Suttner S.Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth. 2007;98:176-182.
79.
Mayer J., Boldt J., Wolf MW, Lang J., Suttner S.Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device . Anesth Analg. 2008;106:867-872.
80.
Mehta Y., Chand RK, Sawhney R., Bhise M., Singh A., Trehan N.Cardiac output monitoring: comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth . 2008;22:394-399.
81.
Opdam HI, Wan L., Bellomo R.A pilot assessment of the FloTrac cardiac output monitoring system . Intensive Care Med. 2007;33:344-349.
82.
Prasser C., Bele S., Keyl C., et al. Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration. BMC Anesthesiol. 2007;7:9.
83.
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;99:337-342.
84.
Sander M., Spies CD, Grubitzsch H., Foer A., Muller M., von Heymann C.Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements. Crit Care . 2006;10:R164.
85.
Zimmermann A., Kufner C., Hofbauer S., et al. The accuracy of the Vigileo/FloTrac continuous cardiac output monitor. J Cardiothorac Vasc Anesth . 2008;22:388-393.
86.
Romano SM, Pistolesi M.Assessment of cardiac output from systemic arterial pressure in humans . Crit Care Med. 2002;30:1834-1841.
Compton F., Wittrock M., Schaefer JH, Zidek W., Tepel M., Scholze A.Noninvasive cardiac output determination using applanation tonometry-derived radial artery pulse contour analysis in critically ill patients. Anesth Analg. 2008;106:171-174.
89.
Scolletta S. , Romano SM, Biagioli B., Capannini G., Giomarelli P.Pressure recording analytical method (PRAM) for measurement of cardiac output during various haemodynamic states. Br J Anaesth. 2005;95:159-165.
90.
Bland JM, Altman DGStatistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307-310.
91.
Critchley LA , Critchley JAA meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques . J Clin Monit Comput. 1999;15:85-91.
92.
Botero M., Lobato EBAdvances in noninvasive cardiac output monitoring: an update. J Cardiothorac Vasc Anesth. 2001;15:631-640.
93.
Engoren M., Barbee D.Comparison of cardiac output determined by bioimpedance, thermodilution, and the Fick method. Am J Crit Care. 2005;14:40-45.
94.
Leslie SJ, McKee S., Newby DE, Webb DJ, Denvir MANon-invasive measurement of cardiac output in patients with chronic heart failure. Blood Press Monit. 2004;9: 277-280.
95.
Sageman WS, Riffenburgh RH, Spiess BDEquivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth. 2002;16:8-14.
96.
Spiess BD, Patel MA, Soltow LO, Wright IHComparison of bioimpedance versus thermodilution cardiac output during cardiac surgery: evaluation of a second-generation bioimpedance device. J Cardiothorac Vasc Anesth. 2001; 15:567-573.
97.
Squara P., Denjean D., Estagnasie P., Brusset A., Dib JC, Dubois C.Noninvasive cardiac output monitoring (NICOM): a clinical validation . Intensive Care Med. 2007;33: 1191-1194.
98.
Suttner S., Schollhorn T., Boldt J., et al. Noninvasive assessment of cardiac output using thoracic electrical bioimpedance in hemodynamically stable and unstable patients after cardiac surgery: a comparison with pulmonary artery thermodilution. Intensive Care Med. 2006;32:2053-2058.
99.
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;34:257-263.
100.
Kim JJ, Dreyer WJ, Chang AC, Breinholt JP, 3rd, Grifka RGArterial pulse wave analysis: An accurate means of determining cardiac output in children. Pediatr Crit Care Med. 2006;7:532-535.
101.
Yamashita K. , Nishiyama T., Yokoyama T., Abe H., Manabe M.Cardiac output by PulseCO is not interchangeable with thermodilution in patients undergoing OPCAB. Can J Anaesth . 2005;52:530-534.
102.
Yamashita K., Nishiyama T., Yokoyama T., Abe H., Manabe M.Effects of vasodilation on cardiac output measured by PulseCO. J Clin Monit Comput . 2007;21:335-339.
103.
Dorman T., Breslow MJ, Lipsett PA, et al. Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit Care Med. 1998;26: 1646-1649.
104.
Sander M., Spies CD, Foer A., von Heymann C.Cardiac output measurement by arterial waveform analysis in cardiac surgery-a comparison of measurements derived from waveforms of the radial artery versus the ascending aorta. J Int Med Res. 2008;36:414-419.
