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

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

Bernd Saugel  1 , Karim Kouz  2 , Thomas W L Scheeren  3 , Gillis Greiwe  2 , Phillip Hoppe  2 , Stefano Romagnoli  4 , Daniel de Backer  5
Affiliations
Free article
Review

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

Bernd Saugel et al. Br J Anaesth. 2021 Jan.
Free article

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.

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Conflict of interest statement

Declarations of interest BS has received honoraria for consulting, honoraria for giving lectures, and refunds of travel expenses from Edwards Lifesciences (Irvine, CA, USA). BS has received honoraria for consulting, institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from Pulsion Medical Systems (Feldkirchen, Germany). BS has received institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from CNSystems Medizintechnik (Graz, Austria). BS has received institutional restricted research grants from Retia Medical (Valhalla, NY, USA). BS has received honoraria for giving lectures from Philips Medizin Systeme Böblingen (Böblingen, Germany). BS has received honoraria for consulting, institutional restricted research grants, and refunds of travel expenses from Tensys Medical (San Diego, CA, USA). TWLS received research grants and honoraria for consulting and lecturing from Edwards Lifesciences and Masimo (Irvine, CA, USA) and honoraria for lecturing from Pulsion Medical Systems. SR has received honoraria and consultation fees from Vygon (Ecouen, France), Masimo, MSD (Kenilworth, NJ, USA), Medigas (Assago, Italy), Baxter (Rome, Italy), BBraun (Melsungen, Germany), Orion Pharma (Espoo, Finland), and Medtronic (Minneapolis, MN, USA). DDB has received honoraria for consulting from Edwards Lifesciences. The other authors declare that they have no conflicts of interest.

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