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The esCCO technology has been developed by Nihon Kohden based on our PWTT parameter. The aim of esCCO is to add extra hemodynamic information to increase patient safety, by facilitating goal-driven therapy and fluid optimization without any additional procedures. EsCCO provides reliable information at each stage of the patient pathway despite the level of invasiveness. Our unique pulse wave transit time (PWTT) measurement is a reliable technology to enhance patient safety and establish a solid foundation to provide extra information with esCCO.

One of the most common complications in surgical patients is hypotension and shock. Our PWTT and iNIBP technologies work together to monitor blood pressure and anticipate any changes before they occur, even if the patient is monitored non-invasively. 

PWTT measures the time from the peak of the R-wave in the ECG to the rising point of the pulse waveform sensed by a Nihon Kohden SpO₂ finger probe. If PWTT exceeds the threshold, it triggers an additional non-invasive blood pressure measurement that can support early detection and treatment of any sudden changes in blood pressure between programmed non-invasive measurements. 

In addition, besides traditional NIBP measurements, our unique iNIBP algorithm offers faster and gentler blood pressure readings as it measures during cuff inflation. PWTT is included in all our patient monitors and it works for both IBP and NIBP monitoring. This automation helps you enhance patient safety, while the clinical team can focus on its core activities along the care pathway.

Pulse wave transit time (PWTT) consists of three sub-periods. PEP (pre-ejection period) counts from the ECG R-wave to the rise point of the aortic root pressure wave. It shortens with increasing cardiac contractility. T1 then counts to the rise point of the radial artery pressure wave. It depends on arterial compliance, shortening with increasing blood pressure. Finally, T2 counts to the rise point of the pulse oximetry wave, as measured by ant SpO₂ probe on the fingertip. This reflects vascular resistance, and shortens with vasodilation.

Estimated continuous cardiac output (esCCO): Our innovative esCCO technology uses PWTT and standard monitoring parameters (ECG, SpO₂, and either NIBP or IBP) to continuously estimate cardiac output. During fluid resuscitation in the OR, perioperative goal-directed therapy and postoperative outcomes are shown to be closely related. Hemodynamic trends derived from esCCO measurements are a reliable source of information to deliver the right amount of fluid to each patient.

EsCCO technology can be used either with IBP or NIBP, enabling continuous, accurate and patient-specific hemodynamic trend monitoring along the entire clinical pathway. Managing and monitoring hemodynamic trends can help improve the quality of care in perioperative, emergency, high-dependency and intensive care settings.
 

EsCCO can also be continuously used and calibrated when patients are undergoing higher-risk procedures and the hemodynamic monitor of choice is more invasive (e.g. bolus thermodilution). Moreover, when the risks surrounding these patients decrease, hemodynamic monitoring can continue with esCCO. EsCCO can be in our patient monitors (optional), without requiring extra procedures, equipment or additional knowledge for implementation.

Whatever your patient’s current risk level, esCCO is at your side. You can apply either non-invasive or invasive methods to calibrate and use esCCO. Observe continuous estimated cardiac output without restriction, throughout a patient’s clinical journey.