Cardiac Output Measurements

Cardiac Cycle
Cardiac output

• Volume of blood ejected from left ventricle

in one minute
• It is the determinant of global oxygen
transport from the heart to the body
• It reflects the efficiency of cardiovascular
system
• There no absolute value for cardiac output
measurement
Cardiac output influencing factors

Ventricular Preload
- Volume of blood in the ventricle at the end of
diastole
- Any changes in the ventricular preload will affect
the ventricular stroke volume
Cardiac output influencing factors

Ventricular Preload
Frank- Starling Mechanism

• The ability of the heart to change its force

of contraction and therefore stroke volume
in response to changes in venous return
I.E ( the greater the diastolic volume or fiber
stretch at the end of diastole the stronger
the force of contraction at systole
• The force of contraction will decline once
this physiological limit has reached
Methods of calculating and measuring
cardiac output
Fick Principle: “gold standard”
CO = VO2 / O2 art – O2 ven
Arterial O2 = Hb x 1.34 x O2 sat.
Venous O2 = Mixed venous blood
VO2 = Oxygen consumption

• 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
• Fick cardiac outputs are infrequently used because difficulties in
collecting and analyzing exhaled gas conc. In critically ill patients
because may not have normal VO2 value
Methods of calculating and measuring
cardiac output
Thermodilution Method
• Based on how fast the flowing blood can dilute
the substances introduced into the circulation
• Stewart-Hamilton Equation:
CO = I x 60 / cm x t x 1/k

• Area under the curve is inversely proportion to

the rate of blood flow. This flow is equivalent to
cardiac output in the absence of shunt
Methods of calculating and measuring
cardiac output
Thermodilution Curve
Thermal dilution method

Limitations
• Affected by the phase of respiration and should
be measured at the same point of respiratory
cycle
• Variations in the speed of cold water injection
can result in altered measurement
Non Invasive Methods

Doppler Method
• Based on measuring the length of blood flow-
velocity in the ascending aorta in unit time.
Multiplied by the cross- sectional area of the
aorta to give stroke volume. Multiplied to heart
rate to give cardiac output.
Methods of calculating and measuring
cardiac output
Impedance plethysmography

• This technique was developed by NASA.

Cardiac output can be measured across
externally electrodes. It measures a changing
impedance in the chest (blood volume). The rate
of change of impedance is a reflection of cardiac
output.

CO = Art. BP / total peripheral vasc. resistance