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Cardiac Output (Fick’s Formula)

Cardiac Output (Fick’s Formula)

Estimates cardiac output by calculating oxygen consumption divided by the arteriovenous oxygen content difference.

Cardiac Output (Fick’s Formula)

Cardiac Output (Fick’s Formula)

Estimates cardiac output by calculating oxygen consumption divided by the arteriovenous oxygen content difference.

Age
Weight
Norm: 1 - 150 kg or 2 - 330 lbs
Height
Norm: 152 - 213 cm or 60 - 84 in (5'0" - 7'0")
SaO₂ As measured on ABG
Norm: 95 - 100 %
%
SvO₂ As measured on mixed venous gas from PA catheter
Norm: 60 - 80 %
%
Hemoglobin
Norm: 12 - 17 g/dL or 120 - 170 g/L
Heart rate
Norm: 60 - 100 beats/min (optional for stroke volume)
beats/min
Cardiac Output
Cardiac Index
Stroke Volume
0/7 answered · enter values to update

Instructions

To use the Fick’s Formula, measure or estimate oxygen consumption (VO₂), arterial oxygen content (CaO₂), and mixed venous oxygen content (CvO₂). Insert the values into the formula to calculate cardiac output. Ensure blood samples are taken simultaneously from arterial and venous sites to avoid timing errors. Oxygen consumption can be directly measured with specialized equipment or estimated using standard formulas. This tool is most reliable when applied in controlled clinical settings, such as catheterization labs or intensive care units, where accurate measurements are possible.

Overview
When to use
Why use
Evidences

Interpretation

CO = VO₂ / (CaO₂ - CvO₂)

Where:

  • CO = Cardiac Output (L/min)

  • VO₂ = Oxygen consumption (mL/min)

  • CaO₂ = Arterial oxygen content (mL O₂/100 mL blood)

  • CvO₂ = Mixed venous oxygen content (mL O₂/100 mL blood)

CO (Cardiac Output), L/min = VO2/ [(SaO2 - SvO2) x Hb x 13.4)]

  • Normal CO: 4–8 L/min in adults

  • Low CO: Suggests impaired cardiac function

  • High CO: May occur in hyperdynamic states

Cardiac output equals whole‑body oxygen consumption divided by the arteriovenous oxygen content difference: CO = VO2 / (CaO2 − CvO2). Oxygen content is usually computed from hemoglobin, O2 saturation, and dissolved O2; mixed venous blood is sampled from the pulmonary artery during right‑heart catheterization.
https://www.ncbi.nlm.nih.gov/books/NBK606091/

A large multicenter cohort (>15,000 RHCs) found poor agreement between thermodilution and estimated‑Fick cardiac output, with >20% discrepancy in over one‑third of patients; thermodilution cardiac index better predicted mortality, suggesting it should be preferred over estimated‑Fick when direct VO2 is not measured
https://jamanetwork.com/journals/jamacardiology/fullarticle/2652883

When VO2 is directly measured (direct Fick via indirect calorimetry), studies show variable agreement with thermodilution: some report poor agreement with potential clinical impact, underscoring that methods are not interchangeable and errors can alter hemodynamic classification.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11865337/

Overview
When to use
Why use
Evidences

The Fick Principle is a foundational method for measuring cardiac output (CO), which reflects the volume of blood pumped by the heart per minute. It is based on the relationship between oxygen consumption and the difference in oxygen content between arterial and venous blood. According to the principle, the amount of oxygen taken up by the lungs per minute must equal the oxygen delivered to tissues by cardiac output multiplied by the arterial–venous oxygen difference.

This method provides an accurate, physiology-based approach for quantifying cardiac function. Unlike indirect methods such as echocardiography, the Fick method is grounded in direct gas exchange principles, making it particularly valuable in research, catheterization labs, and critical care monitoring. Cardiac output assessment is essential for diagnosing and managing conditions such as heart failure, shock, pulmonary hypertension, and congenital heart disease.

The Fick method is considered the gold standard, though its use is limited by the need for invasive measurements (mixed venous oxygen sampling from a pulmonary artery catheter) and challenges in precisely measuring oxygen consumption. In modern practice, estimated VO₂ values are often substituted, but this can reduce accuracy. Nonetheless, the formula continues to serve as a key reference standard against which other methods, including thermodilution and Doppler echocardiography, are validated.

Overview
When to use
Why use
Evidences

Interpretation

CO = VO₂ / (CaO₂ - CvO₂)

Where:

  • CO = Cardiac Output (L/min)

  • VO₂ = Oxygen consumption (mL/min)

  • CaO₂ = Arterial oxygen content (mL O₂/100 mL blood)

  • CvO₂ = Mixed venous oxygen content (mL O₂/100 mL blood)

CO (Cardiac Output), L/min = VO2/ [(SaO2 - SvO2) x Hb x 13.4)]

  • Normal CO: 4–8 L/min in adults

  • Low CO: Suggests impaired cardiac function

  • High CO: May occur in hyperdynamic states

Cardiac output equals whole‑body oxygen consumption divided by the arteriovenous oxygen content difference: CO = VO2 / (CaO2 − CvO2). Oxygen content is usually computed from hemoglobin, O2 saturation, and dissolved O2; mixed venous blood is sampled from the pulmonary artery during right‑heart catheterization.
https://www.ncbi.nlm.nih.gov/books/NBK606091/

A large multicenter cohort (>15,000 RHCs) found poor agreement between thermodilution and estimated‑Fick cardiac output, with >20% discrepancy in over one‑third of patients; thermodilution cardiac index better predicted mortality, suggesting it should be preferred over estimated‑Fick when direct VO2 is not measured
https://jamanetwork.com/journals/jamacardiology/fullarticle/2652883

When VO2 is directly measured (direct Fick via indirect calorimetry), studies show variable agreement with thermodilution: some report poor agreement with potential clinical impact, underscoring that methods are not interchangeable and errors can alter hemodynamic classification.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11865337/

Frequently Asked Questions

Features and Services FAQs

Discover the full range of features and services we offer and how to use them.

What is the principle behind Fick’s Formula?+
How is VO₂ measured?+
What are limitations of the Fick method?+
Is Fick’s method still used in routine practice?+
Can it be used in mechanically ventilated patients?+
How does it compare to thermodilution?+

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