Therapeutical Haemodynamic Decisions Begin with Identifying the Right Cause
Cardiac Output Insights supports clinicians in assessing haemodynamic changes more precisely. The application enables on-demand cardiac output measurement and helps differentiate between vasodilation, hypovolaemia and cardiac dysfunction to support cause-directed therapeutic decisions.
Cardiac Output Cannot Be Directly Derived from Mean Arterial Pressure
The formula MAP = SVR × CO describes the mathematical relationship between mean arterial pressure, systemic vascular resistance and cardiac output. However, cardiac output could only be reliably derived from MAP if systemic vascular resistance remained constant.
During major surgical procedures, vascular resistance may change continuously due to factors such as blood loss, anaesthesia, vasopressor administration or changes in vascular tone. Blood pressure alone therefore does not reliably indicate whether cardiac output is adequate.
Therefore, cardiac output must be directly measured: that means assessing blood flow based on an actual measurement rather than an indirect assumption.
Differentiate haemodynamic changes and identifying whether changes are more likely related to vasodilation, hypovolaemia, or cardiac dysfunction.
A Vasopressor Is Not Always the Right Response to Hypotension
Intraoperative hypotension is a clinical sign that may have different underlying causes. In addition to vasodilation, it may result from hypovolaemia, bradycardia or cardiac dysfunction. A vasopressor may be the appropriate intervention in cases of vasodilation. However, when hypotension is caused by reduced circulating volume or impaired cardiac function, it may not address the underlying problem.
Therefore identifying the cause before treating becomes key to differentiate between the possible haemodynamic causes of hypotension.
A direct measure of Cardiac Output supports a cause-directed intervention that reflects the patient’s individual haemodynamic condition.
How Can You Differentiate the Cause of Intraoperative Hypotension?
Once hypotension has been identified, the next challenge is to determine which haemodynamic mechanism is driving it.
Cardiac output adds an important layer of information to the blood pressure value. Low blood pressure with normal or high cardiac output may point towards vasodilation, whereas low blood pressure combined with reduced cardiac output may indicate hypovolaemia or cardiac dysfunction.
A fluid challenge can provide further information by assessing the patient’s response and helping to distinguish between these possible causes.
Use cardiac output to navigate the diagnostic pathway: combining blood pressure, cardiac output and the response to therapeutic interventions can help narrow down the underlying haemodynamic mechanism.
Different causes require different treatment paths: distinguishing vasodilation, hypovolaemia and cardiac dysfunction supports a more targeted therapeutic approach.
Cardiac Output Monitoring Remains Underused in High-Risk Surgery
Current ESAIC guidance suggests monitoring stroke volume or cardiac output in patients with a high baseline risk of complications or those undergoing high-risk surgery to assess haemodynamic status and the response to therapeutic interventions.
Yet clinical practice shows a significant monitoring gap. Surveys and observational data indicate that cardiac output monitoring is still used in only a minority of high-risk and major surgical patients.
Limited availability remains a barrier: Dedicated cardiac output monitoring technology may not be available when clinicians need additional haemodynamic information.
Cost and additional equipment can restrict routine use: Conventional solutions may require a dedicated monitor as well as specific pressure transducers, adding cost and complexity to perioperative monitoring.
Cardiac Output Insights makes monitoring available on demand: Integrated into the bedside monitor, the application can be activated whenever additional haemodynamic information is required and works with a standard invasive blood pressure transducer.
By reducing the need for dedicated equipment, Cardiac Output Insights helps make cardiac output monitoring more accessible and easier to integrate into the existing clinical workflow.
Cardiac Output Monitoring, Simplified
Cardiac Output monitoring does not have to require additional standalone equipment, specialised setup or unnecessary complexity.
Cardiac Output Insights is integrated directly into the bedside monitor and uses the existing arterial access already in place. This means no specialised standalone monitor needs to be set up.
The measurement can be activated on demand in just 1 second directly from the screen app, compared with around 15 minutes required for conventional Cardiac Output monitoring setups.
Integrated into the bedside monitor: No additional specialised standalone monitor is required.
Uses existing arterial access: Works with the radial or femoral catheter already in place.
Activated on demand: Cardiac Output measurement can be started directly from the monitor when needed.
Designed for simplicity: Reduces setup requirements and makes haemodynamic information more readily accessible in clinical practice.
With Cardiac Output Insights, Cardiac Output monitoring becomes easier to integrate into the existing workflow, helping clinicians access relevant haemodynamic information when they need it.
More Affordable
Cardiac Output monitoring can provide valuable haemodynamic information in high-risk surgical patients, but conventional approaches may require dedicated sensors, specialised standalone monitors and additional equipment, increasing both cost and complexity.
In France, the costs associated with Cardiac Output monitoring have been estimated at approximately €67 million per year. If monitoring were extended to all high-risk surgical patients, these costs could rise substantially.
Cardiac Output Insights is designed to help make Cardiac Output monitoring more affordable and accessible.
Use existing arterial access: The solution works with the radial or femoral catheter already in place, with no need for costly dedicated sensors.
Avoid additional standalone equipment: Cardiac Output Insights is integrated into the bedside patient monitor, reducing the need for specialised standalone monitoring systems.
Activate monitoring on demand: Cardiac Output measurement can be accessed when clinically needed, without adding unnecessary equipment to the workflow.
By making use of existing infrastructure and reducing the need for dedicated hardware and sensors, Cardiac Output Insights can help lower barriers to Cardiac Output monitoring and make haemodynamic insights available to more high-risk surgical patients.
Cardiac Output Insights: Haemodynamic Information at a Glance
- Cardiac Output Insights is an application integrated into the Carevance multiparameter patient monitor, providing cardiac output measurement and visual decision support.
- The solution works with a standard invasive blood pressure transducer and can be activated on demand. It quantifies hypotension when it occurs, provides proactive notifications of relevant changes and supports clinicians in identifying possible causes of haemodynamic instability earlier.
- By adding cardiac output information to blood pressure monitoring, Cardiac Output Insights provides a more comprehensive view of the patient’s cardiovascular status and supports informed, cause-directed treatment decisions.
Sources
2) The Relation Between Mean Arterial Pressure and... : Anesthesia & Analgesia, Michard, F., Wong, A. & Kanoore Edul, V. Visualizing hemodynamics: innovative graphical displays and imaging techniques in anesthesia and critical care. Crit Care 29, 3 (2025). doi.org/10.1186/s13054-024-05239-w
3) 1 Michard F, Chew M, Futier E. Perioperative cardiac output monitoring for the many. Intensive Care Med. 2025 Aug;51(8):1526-1529. doi: 10.1007/s00134-025-08031-8. Epub 2025 Jul 15. PMID: 40663139.
