esCCO Information vol.

A Novel Technology toNon-Invasively MeasureContinuous Cardiac Output
from ECG and SpO2Volumetric Information
for All Care Levels

non-invasive cardiac output measurement
alongside the familiar vital sign parametersof ECG and SpO2.

Nihon Kohden is redefining Quality ofCare with new, non-invasive technologies
like PWTT and esCCO by introducing

Principle of esCCO

volumetric information to all care levels.

The possibility to derive the cardiac output

Since the invention of pulse oximetry by

from pulse pressure information by,

Nihon Kohden researcher Takuo Aoyagi

CO = SV × HR =（K × PP）× HR

in 1974 1）, the pulse wave has become［CO: cardiac output; SV: stroke volume; K:

the most commonly used vital signal

constant value; PP: pulse pressure; HR: heartin clinical practice. The pulse wave canrate］established in various continuous

provide time related information suchcardiac output systems using the pulse-

as intravascular pressure transmission

contour-analysis, built the starting point

as well as information on the volume

for the novel technology esCCO. A bettercha nge of art e rial blood. Estimatedcorrelation between SV and PWTT wasContinuous Cardiac Output（esCCO）is aobserved compared to that between SV

new technology to determine the cardiacand PP2）, and the formula providing cardiac

output using Pulse Wave Transit Timeoutput values was determined to be（PWTT）which is obtained by the pulse

expressed by PWTT-Information as follows;

oximetry and ECG-signals from each cycle

CO = SV × HRof the ECG and peripheral pulse wave.

= K ×（α × PWTT ＋ β）× HR = esCCO

esCCO provides real-time, continuous and［α,β: experimental constants］

Figure 1 : Pulse Wave Transit Time derived from ECG and pulse oximetry signal

1

Redefining
Quality of CareesCCO Information vol.1
Performance of esCCO

N=541, r=0.82（p<0.01）
y=0.82×x＋0.85
16Ishihara et al. reported that esCCO derived

14

from PWTT-Information is highly correlatedwith cardiac output determined bythermodilution technique3）.
In 2009, a multi center study at seven

12
esCCO［L/min］

Early Decision
Making in
Goal Directed Fluid
Management1086

facilities verified the effectiveness of esCCO4

as a practical application（Fig 2）.

20

Reliable Measurement withNon-Invasive Calibration
The ambition in research and development024

6810ICO［L/min］

121416

Figure 2 : Comparison between esCCO andcardiac output by cold bolus thermodilution（ICO）4）though, was the provision of volumetric
information, especially for mid and low carecan be used for calibration. Both calibrationlevels, to improve patient care and enhancemodes reliably track changes in cardiac

patient safety.

output and provide advanced monitoring ofWith that, the challenge was to avoid

a patient’s hemodynamic status（Fig 3）.

any kind of invasive or minimal-invasivecalibration.
By only entering patient information suchas age, gender, height and weight, and an

References

Enhanced Hemodynamic
Monitoring at No Extra Cost

initial NIBP measurement, esCCO determines

Provided over the Nihon Kohden Patienta reference value for calibration and is readyMonitoring Series, esCCO represents a carefor start the measurement. Additionally, aenhancing and economic solution as nocardiac output value obtained by other CO

additional running costs（accessories）related

devices such as by pulmonary artery catheter

to the regular use of the monitor appear.

1）	Severinghaus JW, Honda Y.
History of blood gas analysis. VIIPulse oximetry. J Clin Monit, 1987
Apr; 3:135-138.
2）	Sugo Y, Ukawa T, Takeda S,
Ishihara H, Kazama T, Takeda Z.	A Novel Continuous Cardiac
Output Monitor Based on Pulse
Wave Transit Time. Conf Proc
IEEE Eng Med Biol Soc. 2010;2010; 2853-6
3）	Ishihara et al. A new non-invasive
continuous cardiac output
trend solely utilizing routine
cardiovascular monitors. J ClinMonit, 2004 Dec; 18, 313-320.
4）	T. Yamada, Y. Sugo, J. Takeda,esCCO ResearchTeam.
Verification of a non-invasive
continuous cardiac output
measurement method basedon the pulse-contour analysis
combined with pulse wave
transit time. Eur J Anaesthesiol
2010; 27（Suppl 47）:3AP5-95）	Ralph F. Lee. Cardiac
dysfunction in cirrhosis. Best
Practice & Research Clinical
Gastroenterology, Vol. 21, No. 1,
pp. 125e140, 2007.

8751 SP61-001A ’16. 7. CLB. A.

Figure 3 : Comparison of esCCO, ICO, CCO in ICU post liver transplantation. Postoperative change in cardiac
output of a liver transplantation patient in intensive care unit（ICU）.Cirrhosis is accompanied by various
cardiovascular abnormalities which increase cardiac output（CO）and decrease arterial blood pressure andvascular resistance5）. Therefore, perioperative monitoring of these parameters is extremely important forliver transplantation patients. Figure 3 shows trend of esCCO observed in ICU after liver transplantation.
The cardiac output by cold bolus thermodilution（ICO）is given by red triangle. The esCCO, which was once
calibrated by ICO on ICU admission, was in excellent agreement with ICO and CCO（brown line）measured bypulmonary artery catheter. Despite the underestimation of CO due to decreased vascular resistance, esCCO
calibrated with patient information（gold line）shows an equivalent trend to CCO. These results indicate thatesCCO has a promising performance for tracking change in CO after removal of pulmonary artery catheter.