The non-invasive assessment of stroke volume and cardiac output by impedance cardiography: A review

Impedance cardiography (IC) is an inexpensive, reliable and noninvasive technique for determining stroke volume (SV) and cardiac output (CO). It relies on the measurement of phasic changes in transthoracic electrical resistivity, related to ejection of blood into the ascending aorta with each heart beat. Because of its non-invasive nature, IC is becoming increasingly used in clinical settings, as well as in many areas of physiological research. This paper discusses IC in terms of its theoretical basis, the components of the impedance signal and how impedance data is mathematically processed. One of the major controversies surrounding IC concerns how well it compares with conventional methods of determining SV and CO, such as thermodilution. A literature review of such comparative studies demonstrated that the controversy is far from settled, but that IC is generally agreed to be capable of accurately monitoring trends in cardiovascular dynamics. The question of accuracy of IC in terms of absolute values of SV and CO remains to be determined. The methodological limitations, accuracy, reliability and reproducibility of IC are examined, as are some of the methods developed to improve these aspects of the technique. The application and utility of IC in aerospace medicine research is also addressed.