The ability of a new continuous cardiac output monitor to measure trends in cardiac output following implementation of a patient information calibration and an automated exclusion algorithm

Hironori Ishihara, Yoshihiro Sugo, Masato Tsutsui, Takashige Yamada, Tetsufumi Sato, Toshimasa Akazawa, Nobukazu Sato, Koichi Yamashita, Junzo Takeda

Research output: Contribution to journalArticle

29 Citations (Scopus)


A new non-invasive continuous cardiac output (esCCO) monitoring system solely utilizing a routine cardiovascular monitor was developed, even though a reference cardiac output (CO) is consistently required. Subsequently, a non-invasive patient information CO calibration together with a new automated exclusion algorithm was implemented in the esCCO system. We evaluated the accuracy and trending ability of the new esCCO system. Either operative or postoperative data of a multicenter study in Japan for evaluation of the accuracy of the original version of esCCO system were used to develop the new esCCO system. A total of 207 patients, mostly cardiac surgical patients, were enrolled in the study. Data were manually reviewed to formulate a new automated exclusion algorithm with enhanced accuracy. Then, a new esCCO system based on a patient information calibration together with the automated exclusion algorithm was developed. CO measured with a new esCCO system was compared with the corresponding intermittent bolus thermodilution CO (ICO) utilizing statistical methods including polar plots analysis. A total of 465 sets of CO data obtained using the new esCCO system were evaluated. The difference in the CO value between the new esCCO and ICO was 0.34 ± 1.50 (SD) L/min (95 % confidence limits of -2.60 to 3.28 L/min). The percentage error was 69.6 %. Polar plots analysis showed that the mean polar angle was -1.6 and radial limits of agreement were ±53.3. This study demonstrates that the patient information calibration is clinically useful as ICO, but trending ability of the new esCCO system is not clinically acceptable as judged by percentage error and polar plots analysis, even though it's trending ability is comparable with currently available arterial waveform analysis methods.

Original languageEnglish
Pages (from-to)465-471
Number of pages7
JournalJournal of Clinical Monitoring and Computing
Issue number6
Publication statusPublished - 2012 Dec



  • Cardiac output
  • Measurement technique
  • Non-invasive calibration
  • Pulse contour analysis
  • Pulse wave transit time

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Critical Care and Intensive Care Medicine
  • Health Informatics

Cite this