Cardiac output estimation using pulse wave analysis-physiology, algorithms, and technologies: a narrative review

Bernd Saugel; Karim Kouz; Thomas W L Scheeren; Gillis Greiwe; Phillip Hoppe; Stefano Romagnoli; Daniel de Backer

doi:10.1016/j.bja.2020.09.049

Cardiac output estimation using pulse wave analysis-physiology, algorithms, and technologies: a narrative review

Br J Anaesth. 2021 Jan;126(1):67-76. doi: 10.1016/j.bja.2020.09.049. Epub 2020 Nov 24.

Authors

Bernd Saugel¹, Karim Kouz², Thomas W L Scheeren³, Gillis Greiwe², Phillip Hoppe², Stefano Romagnoli⁴, Daniel de Backer⁵

Affiliations

¹ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA. Electronic address: bernd.saugel@gmx.de.
² Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy; Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy.
⁵ Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 33246581
DOI: 10.1016/j.bja.2020.09.049

Abstract

Pulse wave analysis (PWA) allows estimation of cardiac output (CO) based on continuous analysis of the arterial blood pressure (AP) waveform. We describe the physiology of the AP waveform, basic principles of PWA algorithms for CO estimation, and PWA technologies available for clinical practice. The AP waveform is a complex physiological signal that is determined by interplay of left ventricular stroke volume, systemic vascular resistance, and vascular compliance. Numerous PWA algorithms are available to estimate CO, including Windkessel models, long time interval or multi-beat analysis, pulse power analysis, or the pressure recording analytical method. Invasive, minimally-invasive, and noninvasive PWA monitoring systems can be classified according to the method they use to calibrate estimated CO values in externally calibrated systems, internally calibrated systems, and uncalibrated systems.

Keywords: arterial pressure; cardiovascular dynamics; haemodynamic monitoring; monitor; pulse contour analysis; stroke volume.

Publication types

Review

MeSH terms

Algorithms
Arterial Pressure / physiology
Blood Pressure Determination / methods
Cardiac Output / physiology*
Humans
Monitoring, Physiologic / methods*
Pulse Wave Analysis / methods*
Reproducibility of Results