Feature | Hemodynamic Monitoring Systems | February 23, 2021

Trends in Cardiac Output Monitoring Device Technologies

Advances include machine-learning derived stroke volume, lithium dilution and pulse contour CO, and a shift to noninvasive technologies

Two types of cardiac output monitoring. Left, is the lithium dilution technology is used to monitor and optimize hemodynamics. Show here is the LiDCOplus technology. Right, an example of an invasive pulmonary artery (PA) catheter used for invasive right heart hemodynamic monitoring.

Two types of cardiac output monitoring. Left, is the lithium dilution technology is used to monitor and optimize hemodynamics. Show here is the LiDCOplus technology. Right, an example of an invasive pulmonary artery (PA) catheter used for right heart hemodynamic monitoring.

The overall trend in the cardiac output monitoring market is a movement toward noninvasive or minimally monitoring methods, according to Albany, N.Y., based Transparency Market Research. Here are several trends in the market they recently identified.

Cardiac output is the amount of blood the heart pumps through the circulatory system in minute. Cardiac output is determined by stroke volume and heart rate.

In terms of technology, the global cardiac output monitoring device market can be classified into the following categories:
   • Pulmonary artery catheters
   • Thermodilution pulse contour analysis technique
   • Lithium dilution technique
   • Arterial waveform analysis technique
   • Doppler ultrasound
   • Transthoracic impedance and bioreactance analysis

Transparency Market Research said the North American market held a major share of the global cardiac output monitoring devices market in 2018. They said this is due to the presence of large population suffering from cardiovascular disorder, rise in hospital admission associated with the disease, and increase in reimbursement scenario for patients suffering from cardiovascular disease in the U.S.

Their market analysts said the cardiac output monitoring devices market in Asia Pacific is expected to clock compounded annual growth rate (CAGR) of 5.3% from 2019 to 2027, with the global market's worth to reach about $1.6 billion by 2027.

 

Advances in Cardiac Output Monitoring Devices

Various patient groups need highly accurate estimation of cardiac output (CO). The lithium dilution technique has seen increasing use and popularly among clinicians for good hemodynamic optimization. The technique is quick and simple, requiring an arterial line and central or peripheral venous access. These lines would usually already inserted in critical care patients. A small dose of lithium chloride is injected as an intravenous bolus, and cardiac output is derived from the dilution curve generated by a lithium-sensitive electrode attached to the arterial line.[1] 

In particular, the LiDCOplus technology has gained popularity over the more invasive pulmonary artery catheters (PA catheters, or also referred to as PACS) thermodilution methods. 

The thermodilution technique uses a thermistor-tipped catheter (Swan-Ganz catheter) that is inserted from a peripheral vein into the pulmonary artery. A cold saline solution of known temperature and volume is injected into the right atrium from a proximal catheter port. The injectate mixes with the blood as it passes through the ventricle and into the pulmonary artery, thus cooling the blood. The change in blood temperature is measured by a thermistor at the catheter tip and a computer analyzes the thermodilution profile. This calculates flow (cardiac output from the right ventricle) using the blood temperature information, and the temperature and volume of the injectate. The injection is normally repeated a few times and the cardiac output averaged.[2]

 

Trend Toward Noninvasive Cardiac Stroke Volume Measurements

Minimally invasive cardiac output monitoring (MICOM) devices have gained vast clinical popularity, and are witnessing constant industry effort for technology innovations, Transparency Market Research explained.

The demand for noninvasive methods for the measurement of stroke volume (SV) and CO is a key driver for the expansion of the cardiac output monitoring devices market. Transthoracic echocardiography (TTE) also is emerging as a reliable technique for cardiac functional assessment, especially in the critical care setting. 

Transthoracic impedance and bioreactance analysis technologies also are expected to draw in sizable investment by manufacturers in the cardiac output monitoring devices market. The arterial waveform analysis technique has also acted as a mainstay in CO.

Transthoracic impedance (TI) can be measured by leads placed on the patient's skin and represents the resistance of the thorax to current flow. Changes in tissue composition due to redistribution and movement of fluids induce fluctuations in the TI. Blood flow during the cardiac cycle generates small fluctuations synchronized to each heartbeat. Respiration (or assisted ventilation) also causes changes in the TI.

The resulting thoracic impedance graph, also known as an impedance cardiograph, indirectly reflects the volume changes of the heart and large vessels within the thorax, so it is closely related to the cardiovascular physiological activity and pathological changes. It is widely used to measure cardiac function and to monitor the hemodynamic changes.[3]

Bioreactance is a newer, noninvasive method for cardiac output measurement that involves analysis of blood flow-dependent changes in phase shifts of electrical currents applied across the thorax. It can be used to assess hemodynamic variables.[4]

Arterial waveform analysis allows for noninvasive calculation of derived parameters intrinsically created by a patients pulse pressure profile. These include estimates of left ventricular stroke volume, CO, vascular resistance, and during positive-pressure breathing, SV variation, and pulse pressure variation. In the past decade, arterial waveform analysis has gained a large interest in the overall assessment and management of the critically ill and those at a risk of hemodynamic deterioration.[4]

 

Shift Toward Deep-learning in Cardiac Output Monitoring

Minimally invasive CO monitoring relies on accurate quantification of stroke volume, among other parameters. The CO monitoring devices market has seen commercial use of analysis of the arterial waveform. However, more recently, healthcare providers have come to realize the numerous limitations the technique has. This has created the prospect of artificial intelligence (AI) and machine-learning (ML) techniques in SV, which has boosted the market for deep learning (DL) technologies. 

Particularly, the market is expected to witness high adoption rates of DL-based SV estimations, especially for patients with hemodynamic instability. In coming years, more DL-based models will gather traction among physicians in getting a precise hemodynamic management in operational setting. For instance this may be useful in the intra-operative setting for CO monitoring in pregnant women. 

However, Transparency Market Research said catheter-based measuring will continue to see widespread use in healthcare settings.

 

Pulmonary Artery Catheters Monitoring Guides Pro-active Hemodynamic Decision Making

Invasive, pulmonary artery catheters will continue to attract research and development by cardiac output monitoring devices market players, since it remains the gold standard for quantification of CO. PA catheters have seen continuous technological advancements. The need for accurate and precise CO monitoring devices in modern medicine has further spurred the uptake of newly launched PACs in hospital settings. 

Manufacturers have expanded their functionalities to meet the various CO monitoring requirements of physicians, thereby helping them make pro-active clinical decisions. One example of this is the expanding use of PA catheter monitoring in patients requiring hemodynamic support. This type of precise monitoring can better guide what level of support is needed in critically ill patients, such as Impella, intra-aortic balloon pumps (IABP) or extracorporeal membrane oxygenation (ECMO). 

The presence of high unmet need has made Asian nations highly lucrative in this regard. Medical technology companies will tap into the incremental revenues in the Asia Pacific market over the forecast period.

 

Cardiac Output Monitoring Market Vendors and Trends

Transparency Market Research outlined the following trends and key plays from its research in in this market.

Cardiac Output Monitoring Devices Market Key Driving Factors:

   • Prevalence of strokes to bolster the prospect of CO monitoring devices market
   • Growing worldwide burden of cardiovascular disease boosting technological advancements in CO monitoring devices
   • Need for minimally invasive CO quantifications to expand the horizon for manufacturers
   • Advances in medical infrastructure of developing economies boosting demand in CO monitoring devices market

Cardiac Output Monitoring Devices Market Key Players:

   • Getinge AB
   • Osypka Medical GmbH
   • USCOM Ltd.
   • ICU Medical Inc.
   • Baxter International Inc.
   • GE Healthcare

Other players in the Cardiac Output Monitoring Market:

   • Edward Lifesciences
   • LiDCO Group plc
   • Deltex Medical Group 
   • CNSystems Medizintechnik GmbH

About Transparency Market Research 

Transparency Market Research is a healthcare market intelligence provider, offering fact-based solutions to business leaders, consultants and strategy professionals. The company uses real-time data collection methods and tracks more than 1 million high growth niche products. Links to related Transparency Market Research content:

Cardiac Output Monitoring Devices Market Report - https://www.transparencymarketresearch.com/cardiac-output-monitoring-devices-market.html

Analysis of COVID-19 Impact on Cardiac Output Monitoring Devices Market – https://www.transparencymarketresearch.com/covid19.php

Pulmonary Artery Catheter Market: https://www.transparencymarketresearch.com/pulmonary-artery-catheter-market.html

 

References:

1. Max M Jonas, Suzie J Tanser. Lithium dilution measurement of cardiac output and arterial pulse waveform analysis: an indicator dilution calibrated beat-by-beat system for continuous estimation of cardiac output.Curr Opin Crit Care. 2002 Jun;8(3):257-61. doi: 10.1097/00075198-200206000-00010.

2. Richard E. Klabunde. Measurement of Cardiac Output, Cardiovascular Physiology Concepts. www.cvphysiology.com. Accessed Feb. 23, 2021.

3. Zhao Hui, Kuang Shi-jianga, He Bai-qing, Wang Zi-min and Cheng Xiao-ling. Measurement Method and Principle for Thoracic Impedance Graph. Department of Electronic Engineering, Nanchang Institute of Technology, Nanchang 330044, China. MATEC Web of Conferences 128, 04007 (2017). EITCE 2017. DOI: 10.1051/matecconf/201712804007.

4. T. W. Jones, D. Houghton, S. Cassidy, G. A. MacGowan, M. I. Trenell, D. G. Jakovljevic. Bioreactance is a reliable method for estimating cardiac output at rest and during exercise. BJA: British Journal of Anaesthesia, Volume 115, Issue 3, September 2015, Pages 386–391, https://doi.org/10.1093/bja/aeu560.
 

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