Cardiac Output

Eight o'clock ward round, day two after a coronary artery bypass, and the monitor shows atrial fibrillation at a hundred and fifty. Calum's answer is amiodarone — and that is the single most common wrong answer on the unit. Not because amiodarone is wrong, but because of where it sits in the order.

This is atrial fibrillation on the cardiothoracic intensive care unit, top to bottom. And it matters be...

Last episode we put a probe on the chest. This one goes down the oesophagus — and it starts somewhere uncomfortable.

Inserting a transoesophageal probe is something we do to a patient that can cause them significant harm. Maybe once a year, sometimes more, a patient comes to harm because an anaesthetist put a probe down. We do a great many of these, so it is not unreasonable to think we sometimes cau...

Three in the morning. A patient on the unit is hypotensive, the noradrenaline is going up, and somebody has already given a litre. What is the fastest way to actually know what's wrong?

Put a probe on them.

This is the first of two foundation episodes on echocardiography — the thing that turns a guess into a diagnosis, at the bedside, in about ninety seconds. Today it's transthoracic ech...

Recorded minutes after the live launch at Annual Congress 2026, and published the same day the paper appears in Anaesthesia.

GLIMPSE — the GLP-1 receptor agonist Management in the Peri-operative Setting project — is a national, prospective, multicentre cohort study delivered through the UK resident research networks across all four nations, and it is the largest thing anyone has done on this qu...

Before we touch a single image, we sort out the vocabulary — because almost everyone muddles these devices, and once you have muddled them you cannot reason about them. People say "VAD" and mean five different machines, sitting in different places, for different lengths of time.

So: three questions, and every device answers all three. Which ventricle? How long is it meant to stay in? Surgical or perc...

We've spent a lot of this series on machines — balloon pumps, ECMO circuits, ventricular assist devices. This episode is about the tool that makes all three of them safe.

The argument is that in mechanical circulatory support, transoesophageal echo is not an investigation you order. It is part of the device. It confirms the indication, guides the cannulas in, optimises the support once it is running,...

"Draw me a cardiopulmonary bypass circuit." Venous cannula, reservoir, pump, oxygenator, back to the aorta, cross-clamp, cardioplegia, vents, suckers. Good — that's a pass. The mark comes when you can say what each component does to the patient rather than what it does to the blood, and that is the difference between a trainee who has memorised a diagram and a senior who understands a machine.

This i...

Two in the morning, day one after a long CABG. The patient has a balloon pump in, the augmented pressure has dropped, and the urine output has fallen away over the last three hours. The easiest thing in the world at that hour is to re-zero the transducer, decide the trace looks a bit better, and go back to what you were doing. By the end of this episode you'll know exactly why that's the wrong answer.

This...

Something different this episode. No 3am emergency — instead, a pre-assessment clinic on a Tuesday afternoon, a woman booked for an aortic valve replacement in six weeks, and a haemoglobin of 118. Do you give her intravenous iron?

ITACS, published in The BMJ in August 2026, is the best answer we have ever had to that question. It is also a trial with a great deal to teach about how to read a paper pr...

You will have noticed that consultants tend to give the protamine themselves, and if you're an ST3 who hasn't done much cardiac, nobody asks you to do it. Most people assume that's habit. It isn't.

This is the theatre half of the bleeding week — the drugs, the traps in the tests, and a salvage case at the far end of what's possible. Last episode was the unit.

Please note: the doses and d...