Skip to main content
PMC home page
Heart logoLink to Heart
. 1998 May;79(5):437–441. doi: 10.1136/hrt.79.5.437

Comparison of impedance cardiography and dye dilution method for measuring cardiac output

W Spiering 1, P N van Es 1, P W de Leeuw 1
PMCID: PMC1728690  PMID: 9659188

Abstract

Objective—To assess the degree of agreement between impedance cardiography, using the NCCOM3-R7 device, and the gold standard—the dye dilution method—both under basal conditions and after stimulation of cardiac output.
Patients—35 paired measurements in five healthy male volunteers.
Interventions—To obtain higher levels of cardiac output, cardiac performance was stimulated with a dopamine infusion.
Results—In 35 paired measurements, the mean of all the impedance values was higher than that of the dye dilution values, at 10.2 v 7.4 l/min (p < 0.0001). The mean discrepancy between the two methods was 3.3 l/min, and the mean bias −2.9 l/min, with limits of agreement of −9.0 and 3.2 l/min. A change in cardiac output could not adequately be predicted by the NCCOM3-R7. In 20 of 25 measurements obtained during continuous intravenous dopamine infusions there was a rise in dye dilution cardiac output (range 0.2 to 5.9 l/min). Neither the magnitude nor the direction of the change in dye dilution values corresponded with the change measured by impedance cardiography. The mean discrepancy here between the two methods was 1.8 l/min, and the mean bias −0.8 l/min, with limits of agreement of −4.9 and 3.3 l/min.
Conclusions—In healthy volunteers, impedance cardiography with NCCOM3-R7 is inadequate for assessing cardiac output when compared with the dye dilution method.

 Keywords: cardiac output;  impedance cardiography;  dye dilution

Full Text

The Full Text of this article is available as a PDF (124.2 KB).

Figure 1  .

Figure 1  

Open in a new tab

All paired measurements (n = 35): Pearson's correlation coefficient.

Figure 2  .

Figure 2  

Open in a new tab

All paired measurements (n = 35): Bland-Altman method.

Figure 3  .

Figure 3  

Open in a new tab

Changes in cardiac output during dopamine infusion (n = 25): Bland-Altman method.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appel P. L., Kram H. B., Mackabee J., Fleming A. W., Shoemaker W. C. Comparison of measurements of cardiac output by bioimpedance and thermodilution in severely ill surgical patients. Crit Care Med. 1986 Nov;14(11):933–935. doi: 10.1097/00003246-198611000-00004. [DOI] [PubMed] [Google Scholar]
  2. Appel P. L., Kram H. B., Mackabee J., Fleming A. W., Shoemaker W. C. Comparison of measurements of cardiac output by bioimpedance and thermodilution in severely ill surgical patients. Crit Care Med. 1986 Nov;14(11):933–935. doi: 10.1097/00003246-198611000-00004. [DOI] [PubMed] [Google Scholar]
  3. Belardinelli R., Ciampani N., Costantini C., Blandini A., Purcaro A. Comparison of impedance cardiography with thermodilution and direct Fick methods for noninvasive measurement of stroke volume and cardiac output during incremental exercise in patients with ischemic cardiomyopathy. Am J Cardiol. 1996 Jun 15;77(15):1293–1301. doi: 10.1016/s0002-9149(97)89153-9. [DOI] [PubMed] [Google Scholar]
  4. Bernstein D. P. A new stroke volume equation for thoracic electrical bioimpedance: theory and rationale. Crit Care Med. 1986 Oct;14(10):904–909. doi: 10.1097/00003246-198610000-00017. [DOI] [PubMed] [Google Scholar]
  5. Bernstein D. P. Continuous noninvasive real-time monitoring of stroke volume and cardiac output by thoracic electrical bioimpedance. Crit Care Med. 1986 Oct;14(10):898–901. doi: 10.1097/00003246-198610000-00015. [DOI] [PubMed] [Google Scholar]
  6. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  7. Braden D. S., Leatherbury L., Treiber F. A., Strong W. B. Noninvasive assessment of cardiac output in children using impedance cardiography. Am Heart J. 1990 Nov;120(5):1166–1172. doi: 10.1016/0002-8703(90)90132-h. [DOI] [PubMed] [Google Scholar]
  8. Castor G., Molter G., Helms J., Niedermark I., Altmayer P. Determination of cardiac output during positive end-expiratory pressure--noninvasive electrical bioimpedance compared with standard thermodilution. Crit Care Med. 1990 May;18(5):544–546. doi: 10.1097/00003246-199005000-00017. [DOI] [PubMed] [Google Scholar]
  9. Clancy T. V., Norman K., Reynolds R., Covington D., Maxwell J. G. Cardiac output measurement in critical care patients: Thoracic Electrical Bioimpedance versus thermodilution. J Trauma. 1991 Aug;31(8):1116–1121. [PubMed] [Google Scholar]
  10. Conway J. Clinical assessment of cardiac output. Eur Heart J. 1990 Dec;11 (Suppl 1):148–150. doi: 10.1093/eurheartj/11.suppl_i.148. [DOI] [PubMed] [Google Scholar]
  11. Easterling T. R., Benedetti T. J., Carlson K. L., Watts D. H. Measurement of cardiac output in pregnancy by thermodilution and impedance techniques. Br J Obstet Gynaecol. 1989 Jan;96(1):67–69. doi: 10.1111/j.1471-0528.1989.tb01578.x. [DOI] [PubMed] [Google Scholar]
  12. Gotshall R. W., Wood V. C., Miles D. S. Comparison of two impedance cardiographic techniques for measuring cardiac output in critically ill patients. Crit Care Med. 1989 Aug;17(8):806–811. doi: 10.1097/00003246-198908000-00017. [DOI] [PubMed] [Google Scholar]
  13. Huang K. C., Stoddard M., Tsueda K. A., Heine M. F., Thomas M. H., White M., Wieman T. J. Stroke volume measurements by electrical bioimpedance and echocardiography in healthy volunteers. Crit Care Med. 1990 Nov;18(11):1274–1278. doi: 10.1097/00003246-199011000-00018. [DOI] [PubMed] [Google Scholar]
  14. Introna R. P., Pruett J. K., Crumrine R. C., Cuadrado A. R. Use of transthoracic bioimpedance to determine cardiac output in pediatric patients. Crit Care Med. 1988 Nov;16(11):1101–1105. doi: 10.1097/00003246-198811000-00004. [DOI] [PubMed] [Google Scholar]
  15. Jensen L., Yakimets J., Teo K. K. A review of impedance cardiography. Heart Lung. 1995 May-Jun;24(3):183–193. doi: 10.1016/s0147-9563(05)80036-6. [DOI] [PubMed] [Google Scholar]
  16. Jewkes C., Sear J. W., Verhoeff F., Sanders D. J., Foëx P. Non-invasive measurement of cardiac output by thoracic electrical bioimpedance: a study of reproducibility and comparison with thermodilution. Br J Anaesth. 1991 Dec;67(6):788–794. doi: 10.1093/bja/67.6.788. [DOI] [PubMed] [Google Scholar]
  17. Kubicek W. G., Karnegis J. N., Patterson R. P., Witsoe D. A., Mattson R. H. Development and evaluation of an impedance cardiac output system. Aerosp Med. 1966 Dec;37(12):1208–1212. [PubMed] [Google Scholar]
  18. Lund-Johansen P. The dye dilution method for measurement of cardiac output. Eur Heart J. 1990 Dec;11 (Suppl 1):6–12. doi: 10.1093/eurheartj/11.suppl_i.6. [DOI] [PubMed] [Google Scholar]
  19. Masaki D. I., Greenspoon J. S., Ouzounian J. G. Measurement of cardiac output in pregnancy by thoracic electrical bioimpedance and thermodilution. A preliminary report. Am J Obstet Gynecol. 1989 Sep;161(3):680–684. doi: 10.1016/0002-9378(89)90379-7. [DOI] [PubMed] [Google Scholar]
  20. Moore R., Sansores R., Guimond V., Abboud R. Evaluation of cardiac output by thoracic electrical bioimpedance during exercise in normal subjects. Chest. 1992 Aug;102(2):448–455. doi: 10.1378/chest.102.2.448. [DOI] [PubMed] [Google Scholar]
  21. Northridge D. B., Findlay I. N., Wilson J., Henderson E., Dargie H. J. Non-invasive determination of cardiac output by Doppler echocardiography and electrical bioimpedance. Br Heart J. 1990 Feb;63(2):93–97. doi: 10.1136/hrt.63.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. O'Connell A. J., Tibballs J., Coulthard M. Improving agreement between thoracic bioimpedance and dye dilution cardiac output estimation in children. Anaesth Intensive Care. 1991 Aug;19(3):434–440. doi: 10.1177/0310057X9101900323. [DOI] [PubMed] [Google Scholar]
  23. Pepke-Zaba J., Higenbottam T. W., Dinh Xuan A. T., Scott J. P., English T. A., Wallwork J. Validation of impedance cardiography measurements of cardiac output during limited exercise in heart transplant recipients. Transpl Int. 1990 Jul;3(2):108–112. doi: 10.1007/BF00336214. [DOI] [PubMed] [Google Scholar]
  24. Preiser J. C., Daper A., Parquier J. N., Contempré B., Vincent J. L. Transthoracic electrical bioimpedance versus thermodilution technique for cardiac output measurement during mechanical ventilation. Intensive Care Med. 1989;15(4):221–223. doi: 10.1007/BF00271054. [DOI] [PubMed] [Google Scholar]
  25. Sageman W. S., Amundson D. E. Thoracic electrical bioimpedance measurement of cardiac output in postaortocoronary bypass patients. Crit Care Med. 1993 Aug;21(8):1139–1142. doi: 10.1097/00003246-199308000-00011. [DOI] [PubMed] [Google Scholar]
  26. Salandin V., Zussa C., Risica G., Michielon P., Paccagnella A., Cipolotti G., Simini G. Comparison of cardiac output estimation by thoracic electrical bioimpedance, thermodilution, and Fick methods. Crit Care Med. 1988 Nov;16(11):1157–1158. doi: 10.1097/00003246-198811000-00015. [DOI] [PubMed] [Google Scholar]
  27. Shimizu H., Seki S., Mizuguchi A., Tsuchida H., Watanabe H., Namiki A. [Cardiac output monitoring by impedance cardiography in cardiac surgery]. Masui. 1990 Apr;39(4):508–512. [PubMed] [Google Scholar]
  28. Shoemaker W. C., Appel P. L., Kram H. B., Nathan R. C., Thompson J. L. Multicomponent noninvasive physiologic monitoring of circulatory function. Crit Care Med. 1988 May;16(5):482–490. doi: 10.1097/00003246-198805000-00004. [DOI] [PubMed] [Google Scholar]
  29. Silke B. Non-invasive determination of cardiac output by Doppler echocardiography and electrical bioimpedance. Br Heart J. 1990 Nov;64(5):347–348. doi: 10.1136/hrt.64.5.347-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Smith S. A., Russell A. E., West M. J., Chalmers J. Automated non-invasive measurement of cardiac output: comparison of electrical bioimpedance and carbon dioxide rebreathing techniques. Br Heart J. 1988 Mar;59(3):292–298. doi: 10.1136/hrt.59.3.292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Spahn D. R., Schmid E. R., Tornic M., Jenni R., von Segesser L., Turina M., Baetscher A. Noninvasive versus invasive assessment of cardiac output after cardiac surgery: clinical validation. J Cardiothorac Anesth. 1990 Feb;4(1):46–59. doi: 10.1016/0888-6296(90)90447-n. [DOI] [PubMed] [Google Scholar]
  32. Spinale F. G., Reines H. D., Crawford F. A., Jr Comparison of bioimpedance and thermodilution methods for determining cardiac output: experimental and clinical studies. Ann Thorac Surg. 1988 Apr;45(4):421–425. doi: 10.1016/s0003-4975(98)90016-9. [DOI] [PubMed] [Google Scholar]
  33. Thomas A. N., Ryan J., Doran B. R., Pollard B. J. Bioimpedance versus thermodilution cardiac output measurement: the Bomed NCCOM3 after coronary bypass surgery. Intensive Care Med. 1991;17(7):383–386. doi: 10.1007/BF01720674. [DOI] [PubMed] [Google Scholar]
  34. Thomas S. H. Impedance cardiography using the Sramek-Bernstein method: accuracy and variability at rest and during exercise. Br J Clin Pharmacol. 1992 Dec;34(6):467–476. [PMC free article] [PubMed] [Google Scholar]
  35. Tibballs J. A comparative study of cardiac output in neonates supported by mechanical ventilation: measurement with thoracic electrical bioimpedance and pulsed Doppler ultrasound. J Pediatr. 1989 Apr;114(4 Pt 1):632–635. doi: 10.1016/s0022-3476(89)80710-3. [DOI] [PubMed] [Google Scholar]
  36. White S. W., Quail A. W., de Leeuw P. W., Traugott F. M., Brown W. J., Porges W. L., Cottee D. B. Impedance cardiography for cardiac output measurement: an evaluation of accuracy and limitations. Eur Heart J. 1990 Dec;11 (Suppl 1):79–92. doi: 10.1093/eurheartj/11.suppl_i.79. [DOI] [PubMed] [Google Scholar]
  37. Wong D. H., Tremper K. K., Stemmer E. A., O'Connor D., Wilbur S., Zaccari J., Reeves C., Weidoff P., Trujillo R. J. Noninvasive cardiac output: simultaneous comparison of two different methods with thermodilution. Anesthesiology. 1990 May;72(5):784–792. doi: 10.1097/00000542-199005000-00002. [DOI] [PubMed] [Google Scholar]
  38. Woo M. A., Hamilton M., Stevenson L. W., Vredevoe D. L. Comparison of thermodilution and transthoracic electrical bioimpedance cardiac outputs. Heart Lung. 1991 Jul;20(4):357–362. [PubMed] [Google Scholar]
  39. Yakimets J., Jensen L. Evaluation of impedance cardiography: comparison of NCCOM3-R7 with Fick and thermodilution methods. Heart Lung. 1995 May-Jun;24(3):194–206. doi: 10.1016/s0147-9563(05)80037-8. [DOI] [PubMed] [Google Scholar]
  40. de Leeuw P. W., Birkenhäger W. H. Some comments on the usefulness of measuring cardiac output by dye dilution. Eur Heart J. 1990 Dec;11 (Suppl 1):13–16. doi: 10.1093/eurheartj/11.suppl_i.13. [DOI] [PubMed] [Google Scholar]
  41. de Mey C., Enterling D. Noninvasive assessment of cardiac performance by impedance cardiography: disagreement between two equations to estimate stroke volume. Aviat Space Environ Med. 1988 Jan;59(1):57–62. [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES