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Table 1 Available cardiac output monitoring systems with their respective advantages and disadvantages

From: Clinical review: Does it matter which hemodynamic monitoring system is used?

Technology

System

Invasiveness

Mechanism

Advantages

Disadvantages

Outcome studies

Pulmonary artery catheter

Vigilance

+++

Thermodilution

Gold standard for continuous/intermittent cardiac output monitoring. Allows measuring pulmonary pressures and mixed venous oxygen saturation.

No dynamic parameters of fluid responsiveness, Provides cardiac output information every few minutes.

-

Calibrated pulse contour analysis

PiCCO plus

++

Transpulmonary thermodilution + pulse contour analysis

Continuous cardiac output monitoring. Central venous oxygen saturation with specific device. Good accuracy.

Remains significantly invasive. Requires a specific femoral artery catheter.

0

 

VolumeView

++

Transpulmonary thermodilution + pulse contour analysis

Continuous cardiac output monitoring. Central venous oxygen saturation with specific device. Good accuracy.

Remains significantly invasive. Requires a specific femoral artery catheter.

0

 

LiDCO plus

+

Lithium dilution

Continuous cardiac output monitoring.

 

+

Uncalibrated pulse contour analysis

FloTrac

+

Pulse wave analysis

Continuous cardiac output monitoring. Mini-invasive, self-calibration systems.

Accuracy of cardiac output has been a concern. Sensitive to changes in vasomotor tone. Requires a specific arterial pressure sensor.

+

 

LiDCO Rapid

+

Pulse wave analysis

Continuous cardiac output monitoring. Mini-invasive, self-calibration systems. Can be used with any arterial line and arterial pressure sensor.

Not enough validation studies.

0

 

Pulsioflex

+

Pulse wave analysis

Continuous cardiac output monitoring. Mini-invasive, self-calibration systems. Can be used with any arterial line and arterial pressure sensor.

No validation study.

0

 

PRAM

+

Pulse wave analysis

Continuous cardiac output monitoring. Mini-invasive, self-calibration systems.

Not enough validation studies. Requires a specific arterial kit.

0

 

Nexfin

0

Non-invasive pulse wave analysis

Continuous cardiac output monitoring. Completely non-invasive, self-calibration system.

Not enough validation study. Motion artifact.

0

Ultrasound

Cardio Q

0+

Doppler ultrasound

Less invasive then arterial-based systems, qualifies for billable monitoring in the USA.

Requires frequent manipulation for proper position, significant potential for user variability.

+++

 

USCOM

0

Suprasternal ultrasound

Non-invasive cardiac output measurement.

Intermittent. Operator dependent.

0

Bioreactance

NiCOM

0

Bioreactance

Non-invasive continuous cardiac output monitoring.

Few validation studies. Many limitations.

0

Endotracheal bioimpedance

ECOM

+

Bioimpedance

Mini-invasive and continuous cardiac output monitoring.

Few validation studies. Requires a specific arterial kit and a specific endotracheal tube.

0

Thoracic bioimpedance

BioZ

0

Bioimpedance

Non-invasive cardiac output measurement.

Many negative studies in the critical care setting.

0

  1. 0, None; 0+, very slight; + slight; ++, intermediate; +++, severe. PiCCO plus, Pulsion Medical Systems, Irving, TX, USA; VolumeView, Edwards, Irvine, CA, USA; LiDCO plus, LiDCO Ltd, London, UK; FloTrac, Edwards, Irvine, CA, USA; LidCO Rapid, LiDCO Ltd, London, UK; Pulsioflex, Pulsion Medical Systems, Irving, TX, USA; PRAM, Multiple Suppliers; Nexfin, BMEye, Amsterdam, Netherlands; Cardio Q, Deltex Medical Limited, Chichester, West Sussex, UK; USCOM, Uscom, Sydney, Australia; NiCOM, Cheetah Medical, Tel Aviv, Israel; ECOM, ConMed, Irvine, CA, USA; BioZ, CardioDynamics, San Diego, CA, USA.