Electrical Cardiometry

Parameter Definitions

Oct. 2014

Dr. Yasser Nassef

E.C. Non Invasive Hemodynamics – (Latest)
• 4 sensors placed on neck and chest at ONE side

• Current transmitted by outer electrodes and seeks path

of least resistance: blood filled aorta

• Baseline (resistance) is measured using inner electrodes

• With each heartbeat, RBCs alignment change, & blood

volume and velocity in the aorta change

• Corresponding change in conductivity is measured

• Baseline and changes in RBCs and resistance are used

to measure and calculate hemodynamic parameters

• RBCs alignment is the reason for conductivity change

 higher accuracy in different ages
Systole/ Diastole
RBC Alignment
EC Parameters

Measured Parameters Calculated Parameters

• Heart Rate
• Stroke Volume / Index
• Blood Pressure
• Cardiac Output / Index
• ICON (Contractility)
• SVR / SVRI
• Thoracic Fluid Content
• LCW / LCWI
• FTC (Flow Time Corrected)
• Systolic Time Ratio (EF)
• SVV (Intravascular fluid)
• Delivered Oxygen
• Pre-Ejection Period
• Non Invasive HB
• LV Ejection Time
Thoracic Fluid Content

• Thoracic Fluid Content (TFC)

represent the total fluids in the chest
of the patient
• Intravascular Fluids + Intracellular
fluids + Intra alveolar fluids + Pleural
fluids and interstitial fluids
• 90% of its component is extravascular
fluids
• High TFC means high tissue fluids, or
tissue edema, and low TFC means
low tissue fluids
X-Ray Chest differentiation Pleural Effusion

• Healthy Chest X-Ray Pleural Effusion Chest X-Ray

SVV Stroke Volume Variation

• Stroke volume variation is a naturally occurring

phenomenon due to changes in intra-thoracic pressure .
• The normal range of variation in spontaneously breathing
patients has been reported between 5-10%
• SVV has been shown to have a very high sensitivity when
compared to traditional indicators of volume status and
pre-load (HR, MAP, CVP, PAOP), and their ability to
determine fluid responsiveness
• High SVV means low intravascular fluids, and low pre-load
• Arrhythmia and vasodilators may affect the accuracy of SVV
SVV Calculation
Corrected Flow Time FTc.

• As the heart contracts at a force depends on its inotropy

(power of contraction)and preload (venous return). The
time the heart takes to eject a stroke volume depends on
how large that stroke volume is, which in turn depends on
how was the LVEDV. A low LVEDV (low pre-load) leads to
a low SV and a low FTC, whilst a high LVEDV leads to a
high SV and a long flow time.
• CFT Corrected flow time gives a guide to fluid loading, as
a low FTC is found in hypovolaemia
• LBBB and extremely high SVR are exceptions, as they may
give long FTC while we may have low EDV
Corrected flow Time
ICON (Index of contractility)

• ICON represent the power that the left ventricle

contracts at
• It is measured based on changes in blood speed and
acceleration in the Aorta every beat
• It is very good index of left ventricular contractility
• It is of great helps to easily titrate Inotrope and to
improve COP and contractility for neonates
• (It does not match with EF in many cases)
ICON
Delivered Oxygen (DO2)

• Role of DO2
– Required to sustain life
– Increased metabolic needs in sick patients
• Require Supranormal DO2

• Determinants of DO2
– Cardiac Output / Index
– Arterial O2 Content (Spo2 & Hb)
STR as indication of Ejection Fraction

• Studies evaluated the relationship between EF by

echocardiography and systolic time ratio (STR) in
outpatients with chronic HF. A retrospective chart review
identified 52 patients with EF and STR measured within 2
weeks. There was an inverse correlation between STR and
EF.
• Based on clinical practice: STR reach the end or normal
range, this represent average 40% Ejection Fraction
• And if it reach end of the screen it is less then 30%
• It demonstrated 93% sensitivity and 85% specificity
Ejection Fraction
STR – EF
EC Hemodynamic Parameters
Stroke Volume / Index (SV / SI)
Flow Cardiac Output / Index (CO / CI)

Systemic Vascular Resistance / Index

Resistance (SVR / SVRI)

Systolic Time Ratio (STR) EF

Contractility Cardiac Contractility (ICON)

Thoracic Fluid Content (TFC)

Fluid Stroke Volume Variation (SVV)
Flow Time Corrected (FTC)

Oxygen & Hb Delivered Oxygen DO2

Hemoglobin Non Invasive Hb
Easy (diagnostic) screen
Real Time trend with Markers
Clinical Application of EC in Neonatal Care

1. Establish Baseline to Aid in Initial Assessment and Diagnosis (2 min.)

2. Identify and Initiate Targeted Treatment

3. Determine Response to Treatment

4. Monitor and Optimize Drug Titration

5. Determine Stability for Transfer to Lower Acuity or Discharge (Decrease

Hospital Stay)