January 2026
BJA article describing a new model for considering fluid overload in critically ill patients. Subgroup did include those undergoing cardiac surgery with 5 different fluid overload phenotypes described by the authors.
September 2025
A recent BJA education article outlining some basic principles for managing patients with congential heart disease for non-cardiac surgery. Gives a useful structures approach and provides a sensible framework for managing this complex patient sub-group.
August 2025
This month is something a little different with a blog post from Critical Care Reviews eloquently explaining some of the nuance between selecting Ketamine or Etomidate for RSI. An interesting read.
June 2025
Routine cerebral embolic protection (CEP) during TAVI - The BHF PROTECT-TAVI Trial.
This study in NEJM enrolled patients from 33 centres in the UK in a 1:1 ratio. Disabling stroke occurred in 1.2% of patients in the CEP arm vs 1.4% in the control arm. Other secondary outcomes including access complications were similar between groups.
May 2025
BJA education describing novel strategies for managing vasoplegic shock.
April 2025
The FARES-II Multicenter RCT (Canada and the US) published this month in JAMA:
538 patients of which 420 underwent analysis. 207 entered the FFP group (3u FFP if <60kg, 4u FFP if > 60kg) and 213 entered the PCC group. PCC showed improvements in:
- “Haemostatic effectiveness”,
- Blood product administration (6.6units with PCC vs 9.3 units with FFP)
- Adverse events (36% vs 47%)
- AKI (10% vs 18%)
Importantly this trail used higher doses of PCC (24u/kg) than previous studies, perhaps explaining some of the benefits seen (which were not identified in similar, albeit smaller trials previously) Incidence of thrombotic events was not increased with PCC vs FFP.
March 2025
NEJM article comparing ablation therapy to medical management in ischaemic cardiomyopathy and associated VT.
February 2025
Preoperative Levosimendan in Patients With Severe Left Ventricular Dysfunction Undergoing Isolated Coronary Artery Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials
Meta-analysis JCVA article reviewing the use of Levosimendan pre-operatively in patients with LVEF <35%. Overall there was a mortality benefit (RR 0.31; 95% CI 0.16-0.60) in the intervention group with secondary benefits of post-operative AKI, LCOS and AF also seen.
January 2025
Use of intravenous albumin
CHEST review article outlining indications for IV albumin. Of relevance to cardiac intensive care medicine were 2 out of 14 recommendations which state:
- In adult patients undergoing cardiovascular surgery, intravenous albumin is not suggested for priming the cardiovascular bypass circuit or volume replacement
- In pediatric patients undergoing cardiovascular surgery, intravenous albumin is not suggested for priming the cardiovascular bypass circuit or volume replacement
December 2024
Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis
Article from October outlining benefit of TAVR vs surveillance in the studied population. Primary end-point (death, stroke or unplanned hospitalisation) occured in 26.8% in TAVR group vs 46.3% in the surveillance group. The major difference was seen in unplanned hospitalisation frequency (20.9% vs 40.7%) although there were signifiant differences in death (8.4% vs 9.2%) and stroke (4.2% vs 6.7%) as well. Of note 87% of patients assigned to the surveillance group underwent TAVR during the 3.8 year follow up period.
November 2024
Comprehensive non-invasive haemodynamic assessment in acute decompensated heart failure-related cardiogenic shock: a step towards echodynamics.
Excellent article reviewing the correlation between echo-derived parameters and gold standard PAC-derived parameters in patients with cardiogenic shock. Most validating studies prior to this reviewed stable patients in elective scenarios to establish echo-PAC correlation, this study adds real-world value to echo-assessment of patients with cardiogenic shock.
October 2024
EHJ article detailing the role of 3D echo in the identification and characterisation of endocarditis. Some beautiful 3D images and great summary of the role of 3D echo vs 2D TTE in these cases.
September 2024
SMART Trial
Self-Expanding or Balloon-Expandable TAVR in Patients with a Small Aortic Annulus
NEJM article comparing balloon expandable vs self-expandable TAVI devices in patients with small aortic annulus size (defined as aortic annulus area of 430mm2 or less) 716 patients were enrolled across 13 countries and randomised in a 1:1 fashion. Self-expanding valves were found to be non-inferior to balloon-expandable valves for the primary outcome measures (death, disabling stroke or readmission with HF within 12 months) Self-expandable TAVI was found to be superior in the secondary outcome measure of bioprosthetic valve dysfunction at 12 months (9.4% vs 41.6%)
[Article originally from April 2024]
August 2024
HERACLES Trial
2020 Single-centre double-blinded RCT from Bern, Switzerland looking at hypertonic saline vs normal saline as fluid replacement following cardiac surgery. Hypertonic saline used was 5ml/kg of 7.3% saline administered over 60 minutes on arrival to the CICU. Overall urine output was increased and fluid balance was less positive in the intervention arm but with no difference in absolute fluid volume administered.
July 2024
DACAB Trial evaluating DAPT post CABG
June 2024
SEQUOIA HCM
Aficamten for Symptomatic Obstructive Hypertrophic Cardiomyopathy
An interesting NEJM article describing a phase-2 RCT looking at the efficacy of Aficamten at reducing LVOT gradients in patients with HCM.
142 patients in the intervention group and 140 in the placebo group.
The mean baseline gradient was 55mmHg and outcomes were assessed after 24 weeks. Overall the intervention group had a reduction in LVOT gradient of 45mmHg. All 10 of the other secondary end-points were also statistically better in the intervention group.
May 2024
Finding the optimal tidal volume in ARDS.
Mariangela Pellegrini, Lorenzo Del Sorbo & V. Marco RanieriÂ
Open access journal in ICM detailing how simply dialling in 6ml/kg may not be the optimal strategy in all patients in a heterogenous condition like ARDS.
April 2024
DanGer Shock Trial review - NEJM evaluating Impella microaxial pump device in patients with cardiogenic shock following acute MI (AMI-CS) showing a statistically significant benefit in the intervention group.
March 2024
Review article highlighting key concepts in the management of pulmonary hypertension and RV failure in the cardiac ICU.
December 2023
Recent BJA education article from Dr M.Gilham in New Zealand eloquently explaining some of the commonly misunderstood aspects of epicardial pacing following cardiac surgery in an excellent review article:
November 2023
JCVA review article concerning PCC’s - a useful read prior to launch of our new haemorrhage in cardiac surgery protocol: