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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 20 juin 2019
Doi : 10.1016/j.accpm.2019.05.007
Interchangeability of cardiac output measurements between non-invasive photoplethysmography and bolus thermodilution: A systematic review and individual patient data meta-analysis

Marc-Olivier Fischer a, , Alexandre Joosten b, Olivier Desebbe c, Mariam Boutros a, Stéphane Debroczi a, Ole Broch d, Manu L.N.G. Malbrain e, f, Koen Ameloot g, Christoph K. Hofer h, Şerban-Ion Bubenek-Turconi i, j, Xavier Monnet k, l, Momar Diouf m, Emmanuel Lorne n, o
a Normandy University, UNICAEN, Caen University Hospital, Normandy, Department of Anaesthesiology-Resuscitation and Perioperative Medicine, 14000 Caen, France 
b Department of Anaesthesiology and Intensive Care, University Hospitals Paris-Sud, Paris-Sud University, Paris-Saclay University, Bicêtre Hospital, Paris Public Hospitals Group (AP–HP), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France 
c Department of Anaesthesiology and Intensive Care, Clinique de la Sauvegarde, 7, avenue des Sources, 69009 Lyon, France 
d Department of Anaesthesiology and Intensive Care Medicine, Elbe Hospital Stade, Bremervörder Straße 111, 21682 Stade, Germany 
e Department of Intensive Care, University Hospital Brussels (UZB), Jette, Belgium 
f Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium 
g Department of Intensive Care, Ziekenhuis Oost Limburg (ZOL), Genk, Belgium 
h Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland 
i Department of Cardiovascular Anaesthesiology and Intensive Care of “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania 
j University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania 
k University Hospitals Paris-Sud, Bicêtre Hospital, Department of Intensive Care Medicine-Resuscitation, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France 
l Paris-Sud University, Inserm UMR S 999, 94270 Le Kremlin-Bicêtre, France 
m Department of Biostatistics and Clinical Research, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens, France 
n Anesthesiology and Critical Care Department, Amiens University Hospital, avenue René-Laennec, 80054 Amiens, France 
o Research unit on Simplified Care of Complex Surgical Patients, Jules-Verne University of Picardy, University Centre for Health Research (CURS), chemin du Thil, 80025 Amiens cedex, France 

Corresponding author.

Continuous non-invasive cardiac output devices using digital photoplethysmography (PPG) are widely available for bedside use, but their interchangeability with reference methods has not yet been evaluated in a systematic review and patient data meta-analysis.


A systematic review and meta-analysis of studies comparing non-invasive cardiac output monitoring using PPG with the invasive bolus thermodilution method was performed. With ethical approval, all published studies from the PUBMED, Embase, Scopus, Web of Science, and Google Scholar databases from January 1, 2010 to January 1, 2018 were included. From these analysed studies, individual patient data were interpreted using the interchangeability methods for both absolute values and changes in cardiac output measurements.


Ten studies comparing PPG and bolus thermodilution in the operating room and intensive care settings were included. The interchangeability rate (95% CI) was 37% (24–48) (n =1350 pairs of measurements). The interchangeability rate was poorer with the CNAP device (CNSystems, Graz, Austria) [18% (17–20)] than with the Clearsight (Edwards Lifesciences, Irvine, CA) device [33% (31–34), P <0.0001], for patients receiving norepinephrine [19% (17–20) vs. 33% (32–34), P <0.0001], and for patients with low mean arterial pressure (<65mmHg) [26% (23–29) vs. 30% (29–31), P <0.0001]. Among the 1009 comparisons of the changes in cardiac output between both methods, 561 (56%) were interpretable with a trend interchangeability rate at 24% (12–36).


Cardiac output measurements using PPG were not interchangeable with bolus thermodilution in regard to both absolute values and changes in cardiac output measurements, and should be used with caution in clinical practice.

Trial registration

PROSPERO ID CRD42018089513.

The full text of this article is available in PDF format.

Keywords : Anaesthesiology, Cardiac output, Interchangeability, Monitoring, Photoplethysmography, Thermodilution

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