Cardiac output is an essential determinant of oxygen delivery, although unreliably measured
on clinical examination and routine monitoring. Unfortunately, cardiac output monitoring is
rarely performed in pediatric critical care medicine, with a limited availability of accurate
methods for children. Herein, we report two pediatric cases in which noninvasive pulse-wave
transit time-based cardiac output monitoring (esCCO, Nihon Kohden, Tokyo, Japan) was used. The
esCCO system calculates cardiac output continuously by using the negative correlation between
stroke volume and pulse wave transit time and requires only electrocardiogram monitoring,
noninvasive blood pressure, and pulse oximetry signals. Before starting its use, esCCO should
be calibrated, which can be done using patient information (gender, age, height, and body
weight) or entering cardiac output values obtained by other methods. In both cases, when
calibrations were performed using patient information, the agreement between esCCO and
echocardiographic measurements was poor. However, after calibration with transthoracic
echocardiography, the cardiac output values obtained by both methods remained similar after 2
hours and 18 hours. The results indicate that the esCCO system is suitable for use in children;
however, further studies are needed to optimize its algorithm and determine its accuracy,
precision, and trend in children.