Cardiac Input - Measuring Cardiac Output - Ultrasound Dilution Method

Ultrasound Dilution Method

Ultrasound dilution (UD) uses body temperature normal saline (NS) as an indicator introduced into an extracorporeal loop to create an AV circulation, with an ultrasound sensor used to measure the dilution and then calculate cardiac output using a proprietary algorithm. A number of other hemodynamic variables can also be calculated such as total end-diastole volume (TEDV), central blood volume (CBV) and active circulation volume (ACVI). The UD method was firstly introduced in 1995., and it was used extensively to measure flow and volumes with extracorporeal circuits condition such as ECMO and Hemodialysis, leading more than 150 peer reviewed publications, and now it has adapted to Intensive Care Units (ICU) settings as COstatus (Transonic System Inc. Ithaca, NY). The UD method is based on ultrasound indicator dilution. Blood ultrasound velocity (1560–1585 m/s) is a function of total blood protein concentration (sums of proteins in plasma and in red blood red cells), temperature etc. Injection of body temperature normal saline (ultrasound velocity of saline is 1533m/sec) into a unique AV loop decreases blood ultrasound velocity, and produce dilution curves. UD requires establishment of an extracorporeal circulation through its unique AV loop with two preexisting arterial and central venous lines in ICU patients. When the saline indicator is injected into the A-V loop, it is detected by the venous clamp-on sensor on the AV loop before it enters the patient’s right heart atrium. After the indicator traverses the heart and lung, the concentration curve in the arterial line is recorded and displayed on the COstatus HCM101 Monitor. Cardiac output is calculated from the area of the concentration curve by the classic Stewart-Hamilton equation. It is a non-invasive procedure only by connection the AV loop and two lines of a patient. UD has been specialised for application in pediatric ICU patients, and has been demonstrated to be a relatively safe, although invasive, and reproducible tool.

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