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Cardiac output measurement

The seminar discusses cardiac output monitoring, detailing its importance, historical context, and various methods of measurement. It outlines both invasive and non-invasive techniques, highlighting their advantages and disadvantages. The ideal cardiac output monitor is characterized by safety, accuracy, and continuous measurement capabilities.

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rishavraj9882
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11 views

Cardiac output measurement

The seminar discusses cardiac output monitoring, detailing its importance, historical context, and various methods of measurement. It outlines both invasive and non-invasive techniques, highlighting their advantages and disadvantages. The ideal cardiac output monitor is characterized by safety, accuracy, and continuous measurement capabilities.

Uploaded by

rishavraj9882
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PHYSIOLOGY SEMINAR

CARDIAC OUTPUT MONITORING:


CONVENTIONAL TO NEWER
METHODS

AAKARSH UPADHYAY
OUTLINE/CONTENTS
• HISTORY
• WHAT AND WHY CARDIAC OUTPUT?
• IDEAL CARDIAC OUTPUT MONITOR
• CONVENTIONAL METHODS
• NEWER METHODS
• POSSIBLE METHODS
• SUMMARY
MAN BEHIND TODAY’S TOPIC

Adolf Eugen Fick

• In 1855, he introduced
Fick's laws of diffusion, which govern
the diffusion of a gas across a fluid
membrane.

• In 1870, he was the first to measure


cardiac output, using what is now called
the Fick principle.
WHAT IS CARDIAC OUTPUT?
• It’s the volume of blood ejected by each ventricle per minute.

CARDIAC OUTPUT= STROKE VOLUME X HEART RATE

• It’s the determent of global oxygen transport to the body.


• It reflects the efficiency of cardiovascular system.
WHY TO MEASURE CARDIAC OUTPUT?
• It is an important tool in high risk critically ill surgical patients in
whom large fluid shifts are expected along with bleeding and
hemodynamic instability.

• It is an important component of goal directed therapy (GDT), i.e.,


when a monitor is used in conjunction with administration of fluids
and vasopressors to achieve set therapeutic endpoints thereby
improving patient care and outcome.
Features of a ideal cardiac output
monitor

• Safe and Accurate


• Quick in interpretation and easy to use
• Operator independent i.e. the skill of the operator
doesn't affect the information collected .
• Provide continuous measurement.
• Reliable during various physiological state
ADVANTAGE AND DISADVANTAGE OF METHODS OF CARDIAC OUTPUT MONITORING
No Device Type Advantages Disadvantages

1 PAC( Pulse contour analysis) Invasive Gold standard Catheter related complications

Catheter related complications


2 Continous CO by PAC Invasive Continous CO measurement Cost

Only one arterial line Continuous Requires good arterial waveform


LiDCO( Minimally invasive- Requires Calibration
3 Minimally invasive CO measurements Measure SV
Lithium dilution CO) and SVV Contraindicated in Lithium
therapy

PiCCO(Pulse contour analysis Continuous CO measurement


4 Minimally invasive Effective during hemodynamic Requires good arterial waveform
CO) instability Requires calibration

5 FloTrac Minimally invasive Continuous CO measurement No Requires good arterial waveform


calibration

PRAM(Pressure recording
6 Minimally invasive No calibration Still not validated
analytic method)

Measure flow only in descending


Simple to use Reliable Useful in thoracic aorta Assumptions
7 ED(Esophgeal Doppler) Minimally invasive GDT about aortic size may not be
accurate
Evaluate cardiac
8 TEE(transesophgeal echocardiography ) Minimally invasive anatomy preload and Cost Skilled personnel
ventricular function

Affected by changes in
Ease of use Continuous
9 Partial non-rebreathing systems Non invasive dead space or V/Q
CO measurement
matching

Affected by electrical
noise, movement,
temperature and
Continuous CO
10 Thoracic bioimpedance Non invasive humidity Requires
measurement
hemodynamic stability
Not useful in
dysrhythmias

Coronary blood flow


ECOM(Endotracheal cardiac output Continuous CO not recorded
11 Non invasive
monitor) measurement Electrocautery
produces interference
METHODS OF MEASURING CARDIAC
OUTPUT
INVASIVE METHODS

• FICK PRINCIPLE :-

CARDIAC OUTPUT= VO2 (ml/min) / A-V O2 diff(ml/l)

• Fick Principle relies on the total uptake of a


substances by peripheral tissue is equal to
the product of blood flow to the peripheral
tissue and arterial -venous concentration
difference of the substances
Mixed venous blood is usually obtained

Through a catheter inserted into:-


• The brachial vein of the forearm,
• Through the subclavian vein,
• Down to the right atrium,
• The right ventricle or pulmonary artery

Systemic arterial blood can then be obtained from:-


• any systemic artery in the body.
Indicator dilution method

• Based on how fast the flowing blood can dilute the substances introduced into
the circulation

• A known amount of a substance, such as a dye, is injected into a large systemic


vein or, preferably, into the right atrium.

• The concentration of the dye is recorded as the dye passes through one of the
peripheral arteries, giving a curve
CARDIAC
OUTPUT=
Thermodilution: A popular
indicator dilution technique

• A cold solution of D/W 5% or normal saline


(temperature 0°C) is injected into the right atrium
from a proximal catheter port.
• This solution causes a decrease in blood
temperature in right heart and flows to the
pulmonary artery where the temperature is
measured by a thermistor placed in the
pulmonary artery catheter.
• THERMISTOR- records the change in blood
temperature and sends information to interpret.
• The degree of change is inversely proportional to cardiac
output.
• Temperature change is minimal if there is a high blood
flow but temperature change high if blood flow is low.
NON INVASIVE METHODS

Endotracheal Cardiac Output Monitor


(ECOM)

• ECOM measures CO using impedance plethysmography


• Is based on the principle of bio-impedance.
• Current is passed through electrodes attached to
endotracheal tube shaft and cuff.
• Current is passed from electrode on the shaft of
endotracheal tube and change in impedance secondary
to aortic blood flow is detected by electrode on the cuff.
• SV is calculated based on impedance change and CO
can be calculated.
• Impedance is affected by aortic blood flow
TRANS ESOPHAGEAL
ECHOCARDIOGRAPHY(TEE)/ DOPPLER
• A widely used monitor in perioperative setting
• Is an important tool for the assessment of cardiac structures, filling status and cardiac
contractility
• Aortic pathology can also be detected by TEE
• Doppler technique is used to measure CO by Simpson's rule measuring SV multiplied by HR
• Measurement can be done at the level of pulmonary artery, mitral or aortic valve
• TEE can quantify Cardiac Output more precisely by measuring both the velocity and the
cross-sectional area of blood flow at appropriate locations in the heart or great vessels
i.e. Flow = Cross sec’ area X Velocity
SV= flow X ET (Systolic Ejection time)
*CO=SV X HR
Trans Thoracic Echocardiography
(TTE)
• Echocardiography is cardiac ultrasound
• Can be used to estimate Cardiac Output by direct visualization of the
contracting heart in real time
• Gaining acceptance as one of the safest and most widely used cardiac
output monitors in the critically ill
• Be used to assess cardiac output (intermittently)
• The USCOM™ device targets the pulmonary and aortic valves
accessed via the parasternal and suprasternal windows in order to
assess cardiac output completely non-invasively
SUMMARY

• METHODS OF MEASURING CARDIAC OUTPUT


INVASIVE NONINVASIVE
Pulmonary Artery Catheter I. TEE / Esophageal doppler
Dye , Thermodilution II. Endotracheal Cardiac outcome monitor
Fick’s principle III. Trans thoracic echocardiography(TTE)
REFERENCES

• Yatin M and Dheeraj A, World J Cardiol 2014 ;6(9): 1022-1029 . PMCID


PMC4176793
• Diagnostic and Interventional Cardiology ; Hemodynamic monitoring
System ; 2021
• Antonio Regalado , MIT technology , 2023
• Yerukneh Solomon , cardiac output measurement
ANY QUESTIONS?

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