The bottom line
Strongest for trends, children and newborns
Electrical Cardiometry performs best where it is used most: in neonates and children, and in tracking change, such as the stroke volume response to a leg raise, fluid or a drug. Its average bias against reference methods is small. Like every non-invasive monitor, its single absolute readings in adults do not match invasive thermodilution closely: pooled error is about 47% across all non-invasive devices (Joosten 2017) and 42–48% for Electrical Cardiometry (Sanders 2020). That is why this academy teaches trends and responses to treatment rather than single numbers.
Correlation is not agreement
Two methods can rise and fall together (high r) yet differ by a litre a minute. Look for bias, limits of agreement and percentage error, not just r.
The 30% rule
A percentage error under about 30% is the usual threshold for interchangeability (Critchley and Critchley, 1999). Many bioimpedance studies land near or above it.
Trending is a different question
A monitor can be imprecise for single values yet useful for the direction of change, for example the stroke volume response to a passive leg raise.
Reviews and studies
From meta-analyses to the bedside
✓ supports the method · ~ mixed or descriptive · ≠ single readings not interchangeable with the invasive reference (a limit shared by all non-invasive monitors).
Neonates
| Study | Patients | Compared with | Finding | Verdict |
|---|---|---|---|---|
| Noori et al., 2012 | 20 term newborns, 115 pairs | Echocardiography | Bias −4 mL/min; precision similar to echo; unaffected by a ductus | ✓ |
| Grollmuss and Gonzalez, 2014 | 28 low and very-low-birth-weight infants, 228 pairs | Echocardiography | Within the 30% criterion | ✓ |
| Boet et al., 2016 | 79 stable preterm infants | Echocardiography | Good correlation, variability similar to echo; reference curves | ✓ |
| Hsu et al., 2017 | 36 preterm infants with a significant ductus, 105 pairs | Echocardiography | Percentage error 28.6%: wide but clinically acceptable | ✓ |
| Song et al., 2014 | 40 preterm infants, 108 pairs | Echocardiography | Promising for trends, but poor at low output and affected by ventilation mode | ~ |
Children
| Study | Patients | Compared with | Finding | Verdict |
|---|---|---|---|---|
| Norozi et al., 2008 | 32 children with congenital heart disease | Direct Fick | r = 0.97; acceptable agreement | ✓ |
| Grollmuss et al., 2012 | 24 newborns after arterial switch | Doppler echo | Percentage error 29%: interchangeable | ✓ |
| Rauch et al., 2013 | 64 obese children | Doppler echo | r = 0.91, bias 0.015 L/min | ✓ |
| Blohm et al., 2014 | 72 children in intensive care | Echocardiography | Percentage error 26% overall; preterm infants outside limits | ~ |
| Narula et al., 2017 | Children with structural heart disease | Pulmonary artery catheter | Small bias, good reliability | ✓ |
| Coté et al., 2015 | 402 children under anaesthesia | No reference method | Detected some events before other monitors; some readings were artefacts | ~ |
| Awadhare et al., 2022 | Children with shock in the emergency department | Fluid response | A 15% change in the contractility index predicted fluid responsiveness (AUC 0.85) | ✓ |
Adults
| Study | Patients | Compared with | Finding | Verdict |
|---|---|---|---|---|
| Schmidt et al., 2005 | 37 coronary surgery patients | Transoesophageal Doppler | r² = 0.86, bias 0.18 L/min | ✓ |
| Zoremba et al., 2007 | Intensive care patients | Pulmonary artery thermodilution and PiCCO | Percentage error 26.5% | ✓ |
| Heringlake et al., 2007 | 29 cardiac surgery patients | Pulmonary artery thermodilution | Lack of agreement; did not track changes | ≠ |
| Cox et al., 2017 | 50 cardiac surgery patients | Continuous pulmonary artery catheter | Percentage error over 30% throughout; poor trending | ≠ |
| Greiwe et al., 2025 | 41 patients after bypass surgery | Pulmonary artery thermodilution | Percentage error 47%, concordance 48% | ≠ |
| Song et al., 2025 | 72 intensive care patients | PiCCO | Wide limits of agreement, limited trending | ≠ |
| Raue et al., 2009 | 30 patients with sepsis or SIRS | PiCCO | Percentage error 54% | ≠ |
Obstetrics
| Study | Patients | Compared with | Finding | Verdict |
|---|---|---|---|---|
| Hammad et al., 2019 | 60 women with preeclampsia | Lung ultrasound | Thoracic fluid content detected pulmonary oedema (AUROC 0.94) | ✓ |
| Liu et al., 2015 | 42 caesarean deliveries under spinal | Course over spinal anaesthesia | Output usually rose during spinal hypotension, informing vasopressor choice | ~ |
| Feng and Liu, 2020 | 20 caesarean deliveries | Transthoracic echo | Percentage error 62%; moderate trending | ≠ |
The big picture: pooled reviews
| Review | Scope | Finding | Verdict |
|---|---|---|---|
| Mansfield et al., 2022 | Paediatric meta-analysis, 25 studies | No significant difference in mean values; acceptable in children and adolescents, uncertain in neonates and congenital heart disease | ~ |
| van Wyk et al., 2025 | European neonatal consensus (ESPR) | Useful for tracking change in neonates; not accurate enough for absolute output | ~ |
| O'Neill et al., 2020 | 33 neonatal studies, about 2,000 infants | Narrative review of bioimpedance in neonates | ~ |
| Sanders et al., 2020 | 24 studies of Electrical Cardiometry: 620 adults, 603 children | Bias near zero; percentage error 48% in adults and 42% in children, so single readings do not replace the reference methods | ≠ |
| Joosten et al., 2017 | 37 studies, 1,543 patients, all non-invasive cardiac output devices | Pooled percentage error 47% for the whole category: none is interchangeable with thermodilution | ≠ |
Guidelines and key methods
The framework the academy teaches within
- Consensus on circulatory shock and hemodynamic monitoring (ESICM).Cecconi et al., Intensive Care Medicine 2014: dynamic over static measures; less invasive devices only where validated in shock · doi
- Surviving Sepsis Campaign: international guidelines 2021.Evans et al., Intensive Care Medicine 2021: dynamic measures such as passive leg raise to guide fluids · doi
- Surviving Sepsis Campaign: paediatric guidelines 2020.Weiss et al., Pediatric Critical Care Medicine 2020 · doi
- Prediction of fluid responsiveness by passive leg raising: a meta-analysis.Monnet, Marik and Teboul, Intensive Care Medicine 2016: a 10% rise in output predicts response (sensitivity 0.85, specificity 0.91) · doi
- Passive leg raising: five rules, not a drop of fluid!Monnet and Teboul, Critical Care 2015 · doi
- The meta-analysis of cardiac output: the 30% criterion.Critchley and Critchley, Journal of Clinical Monitoring and Computing 1999 · doi
Research by Dr. Nassef
Electrical Cardiometry in his own work
- Hemodynamic-guided therapy is associated with better hypertension control compared with standard care.Vascular Health and Risk Management, 2026 · 156 patients · first author · doi
- Noninvasive cardiac output monitoring in septic shock patients: a retrospective study on hemodynamic status and outcomes.Medicine, 2025 · 50 patients · senior author · observational, no reference method · doi
- The role of Electrical Cardiometry in paediatric and neonatal anaesthesia and intensive care: a narrative review.Anesthesia and Critical Care, 2022 · senior author · doi
- A pilot crossover trial of helmet ventilation and exercise performance in chronic obstructive pulmonary disease.Scientific Reports, 2022 · doi
- A pilot study of short-term hemodynamic effects of negative pressure ventilation in chronic obstructive pulmonary disease, assessed using electrical cardiometry.Annals of Noninvasive Electrocardiology, 2021 · senior author · doi