Methods and apparatus for monitoring cardiac output

• US 4,796,634 A
• Filed: 08/09/1985
• Issued: 01/10/1989
• Est. Priority Date: 08/09/1985
• Status: Expired due to Fees

• Current Assignee: Lawrence Medical Systems Incorporated
• Original Assignee: Lawrence Medical Systems Incorporated
• Inventors: Barnes, Stephen R., Tarbox, Gary L., McLaren, Barry D., Huntsman, Lee L., Leard, Richard S.
• Primary Examiner(s): Jaworski, Francis J.
• Application Number:
  US06/763,992
• Time in Patent Office: 1,250 Days
• Field of Search: 128/663, 128/713, 364/415-417
• US Class Current: 600/457
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 8/065 to determine blood output from the heart in general A61B5/029
• CPC Class Codes: A61B 8/467 characterised by special input means
• CPC Class Codes: G01P 5/242 involving continuous, e.g. modulated or unmodulated, waves G01P5/244 takes precedence

Abstract

A method and apparatus for ascertaining the cardiac output of a human patient, said method comprising the steps of: measuring the systolic velocity of the blood flowing through the patient'"'"'s descending aorta; determining the cross-sectional area of the patient'"'"'s ascending aorta; and calculating the patient'"'"'s cardiac output from said systolic velocity and said aortic area. The cardiac output can be converted: (1) to cardiac index by dividing it by the patient'"'"'s body surface area, and (2) to systemic vascular resistance by dividing a value representing the patient'"'"'s blood pressure by said cardiac output.

Claims

1. A method for ascertaining the cardiac output of a human patient, said method comprising the steps of:

measuring the systolic velocity of the blood flowing through the patient'"'"'s descending aorta with an ultrasonic probe inserted in the esophagus of the patient;

determining the cross-sectional area of the patient'"'"'s ascending aorta; and

calculating the patient'"'"'s cardiac output from said systolic velocity and said aortic area.

2. A method as defined in claim 1 in which the systolic velocity of the blood flowing through the patient'"'"'s descending aorta is scaled upwardly to the velocity of the blood flowing through his ascending aorta before the calculation of the patient'"'"'s cardiac output is made.

3. A method as defined in claim 2 wherein the systolic velocity of the blood flowing through the patient'"'"'s descending aorta is scaled upwardly to the velocity of the blood flowing through his ascending aorta before the calculation of the patient'"'"'s cardiac output is made by measuring the systolic velocity of the blood flowing through the patient'"'"'s ascending aorta, computing a scaling factor from the aforesaid systolic velocity and the systolic velocity of the blood flowing through the patient'"'"'s descending aorta, and employing said factor to scale the systolic velocity of the patient'"'"'s descending aorta blood flow as aforesaid.

4. A method as defined in claim 3 wherein the velocity of the blood flowing through the patient'"'"'s ascending aorta is measured with an ultrasonic suprasternal notch probe.

5. A method as defined in claim 1 wherein said cardiac output is calculated by:

generating a signal representative of the systolic velocity of the blood flowing through the patient'"'"'s descending aorta;

upwardly scaling that signal from a calibration signal representing a relationship between said systolic velocity representative signal and the velocity of the blood flowing through the patient'"'"'s ascending aorta;

subjecting said first systolic velocity signal to frequency spectrum analysis to produce a multicomponent velocity profile signal;

integrating said velocity profile signal with respect to time to thereby produce a systolic velocity integral;

computing stroke volume as a function of said cross-sectional area and said systolic velocity integral;

summing the stroke volumes thus determined for n beats of the patient'"'"'s heart; and

dividing the resulting sum by the time spanning said n beats.

6. A method as defined in claim 1 wherein the patient'"'"'s aortic area is predictively determined by:

a. determining the age and sex of said patient;

b. measuring the height and weight of said patient;

c. entering the age, sex, height, and weight data thus obtained into a data processing means;

d. instructing the data processing means to execute a program for converting said data to a value indicative of the diameter of the patient'"'"'s aorta; and

e. converting the value indicative of the diameter of the patient'"'"'s ascending aorta into a numerical value indicative of the area of the patient'"'"'s ascending aorta.

7. A method as defined in claim 6 wherein said data processing means is instructed to execute a program which is capable of solving the equation:

space="preserve" listing-type="equation">AD=C.sub.1 +[C.sub.2 ×

AGE]+[C.sub.3 ×

SEX]+[C.sub.4 ×

HEIGHT]+[C.sub.5 ×

WEIGHT]

where;

AD is aortic diameter

C₁ -C₅ are constants,

AGE is the age of the patient in years,

SEX is 0 if the patient is a male and one if the patient is a female,

HEIGHT is the height of the patient in inches, and

WEIGHT is the weight of the patient in pounds.

8. A method for measuring the cardiac output of a human patient, said method comprising the steps of:

determining the cross-sectional area of the patient'"'"'s ascending aorta;

generating a signal representative of the systolic velocity of the blood flowing through the patient'"'"'s descending aorta with an ultrasonic probe inserted in the esophagus of the patient;

upwardly scaling that signal from a calibration signal representing a relationship between said systolic velocity representative signal and the velocity of the blood flowing through the patient'"'"'s ascending aorta;

subjecting said first systolic velocity signal to frequency spectrum analysis to produce a multicomponent velocity profile signal;

integrating said velocity profile signal with respect to time to thereby produce a systolic velocity integral;

computing stroke volume as a function of said cross-sectional area and said systolic velocity integral;

summing the stroke volumes thus determined for n beats of the patient'"'"'s heart; and

dividing the resulting sum by the time spanning said n beats.

9. A method of determining the cardiac index of a human patient which includes the steps of:

computing the cardiac output of the patient by determining the cross-sectional area of the patient'"'"'s ascending aorta, generating a signal representative of the systolic velocity of the blood flowing through the patient'"'"'s descending aorta with an ultrasonic probe inserted in the esophagus of the patient, upwardly scaling that signal from a calibration signal representing a relationship between said systolic velocity representative signal and the velocity of the blood flowing through patient'"'"'s ascending aorta, subjecting said first systolic velocity signal to frequency spectrum analysis to produce a multicomponent velocity profile signal, integrating said velocity profile signal with respect to time to thereby produce a systolic velocity integral, computing stroke volume as a function of said cross-sectional area and said systolic velocity integral, summing the stroke volumes thus determined for n beats of the patient'"'"'s heart, and dividing the resulting sum by the time spanning said n beats to determine said cardiac output, and dividing the cardiac output of the patient by his body surface area.

10. Apparatus for measuring the cardiac output of a human patient, said apparatus including:

means for measuring the systolic velocity of the blood flowing through the patient'"'"'s aorta, said means including an ultrasonic esophageal probe;

means for calculating the cross-sectional area of the patient'"'"'s aorta from his height, weight, age, sex; and

means for calculating the cardiac output of the patient from the thus determined systolic flow velocity and aortic diameter.

11. Apparatus as defined in claim 10 which includes means for generating a signal representative of the systolic velocity of the blood flowing through the patient'"'"'s descending aorta;

means for upwardly scaling that signal from a calibration signal representing a relationship between said systolic velocity representative signal and the velocity of the blood flowing through the patient'"'"'s ascending aorta;

means for performing a frequency spectrum analysis of said first systolic velocity signal to thereby produce a multicomponent velocity profile signal;

means for integrating said velocity profile signal with respect to time to thereby produce a systolic velocity integral;

means for computing stroke volume as a function of said cross-sectional area and said systolic velocity integral;

means for summing the stroke volumes thus determined for n beats of the patient'"'"'s heart; and

means for dividing the results by the time spanning said n beats.

12. Apparatus as defined in claim 11 which includes an ultrasonic suprasternal notch probe for providing a one-time or calibration measurement of the systolic velocity of the blood flowing through the patient'"'"'s ascending aorta, means for computing a scaling factor from that velocity and the systolic flow velocity of the blood flowing through the patient'"'"'s descending aorta, and means for producing said second signal from said just-mentioned systolic flow velocity and said scaling factor.

13. Apparatus as defined in claim 10 which includes a touch sensitive display means via which an operator can interact with the apparatus in the course of measuring the patient'"'"'s cardiac output, said display means including means for displaying instructions to said operator and information on the status of the apparatus and the patient'"'"'s cardiac output.

14. Apparatus as defined in claim 10 which includes means for dividing said cardiac output of the patient by his body surface area and thereby obtaining the cardiac index of the patient.

15. Apparatus as defined in claim 10 which includes means for dividing a value representing the blood pressure of the patient by the cardiac output of the patient and thereby obtaining his systemic vascular resistance.

16. Apparatus as claimed in claim 10 which includes:

a. means into which numerical values representing the age, set, height, and weight of the patient can be written; and

b. data processing means for;

(i) converting said numerical values into one indicative of the diameter of the patient'"'"'s aorta, and (ii) converting the value indicative of the diameter of the patient'"'"'s ascending aorta into a numerical value indicative of the area of the patient'"'"'s ascending aorta.

17. Apparatus as defined in claim 16 wherein said data processing means includes means for solving the equation:

space="preserve" listing-type="equation">AD=C.sub.1 +[C.sub.2 ×

AGE]+[C.sub.3 ×

SEX]+[C.sub.4 ×

HEIGHT]+[C.sub.5 ×

WEIGHT]

where;

AD is aortic diameter,

C₁ -C₅ are constants

AGE is the age of the patient in years,

SEX is 0 if the patient is a male and one if the patient is a female,

HEIGHT is the height of the patient in inches, and

WEIGHT is the weight of the patient in pounds.

18. A method for measuring the systemic vascular resistance of a human patient, said method comprising the steps of:

determining the cross-sectional area of the patient'"'"'s ascending aorta;

generating a signal representative of the systolic velocity of the blood flowing through the patient'"'"'s descending aorta with an ultrasonic probe inserted in the esophagus of the patient;

upwardly scaling that signal from a calibration signal representing a relationship between said systolic velocity representative signal and the velocity of the blood flowing through the patient'"'"'s ascending aorta;

subjecting said first systolic velocity signal to frequency spectrum analysis to produce a multicomponent velocity profile signal;

integrating said velocity profile signal with respect to time to thereby produce a systolic velocity integral;

computing stroke volume as a function of said cross-sectional area and said systolic velocity integral;

summing the stroke volumes thus determined for n beats of the patient'"'"'s heart; and

dividing the resulting sum by a value representing the inverse of the blood pressure of the patient.

19. A method as defined in claim 18 wherein said value has components representing both the patient'"'"'s central venous pressure and his mean arterial pressure.

20. A method of determining the cardiac index of a human patient which includes the steps of computing the cardiac output of the patient by determining the cross-sectional area of the patient'"'"'s ascending aorta, generating a signal representative of the systolic velocity of the blood flowing through the patient'"'"'s descending aorta with an ultrasonic probe inserted in the esophagus of the patient, upwardly scaling that signal from a calibration signal representing a relationship between said systolic velocity representative signal and the velocity of the blood flowing through the patient'"'"'s ascending aorta, subjecting said first systolic velocity signal to frequency spectrum analysis to produce a multicomponent velocity profile signal, integrating said velocity profile signal with respect to time to thereby produce a systolic velocity integral, computing stroke volume as a function of said cross-sectional area and said systolic velocity integral, summing the stroke volumes thus determined for n beats of the patient'"'"'s heart, dividing the resulting sum by the time spanning said n beats to determine said cardiac output, and dividing a value representing the inverse of the blood pressure of the patient by the cardiac output of the patient.

21. A method as defined in claim 20 wherein said value has components representing both the patient'"'"'s central venous pressure and his mean arterial pressure.