Cardiac Out Workshop 2023

On the 8^th of March 2023, JJ&J Specialist Cardiothoracic surgeons together with Surgical Innovations hosted a Cardiac Output Workshop at Redlands Hotel, Pietermaritzburg. The JJ&J team were very excited to be part of this teaching day as “Cardiac Output” just happened to be the March theme of their very own Cardiac Surgery Clinical Academic Program J As a group we are approaching our ERAS Cardiac launch and one of the guidelines we are very passionate about is Goal-directed fluid therapy, which you need Cardiac Output monitoring to achieve. There is abundant evidence to show improved patient outcomes if fluids are administered appropriately. (shorter length of stay etc)

There are of course other indications/functions that we are interested in such as:

-PICCO monitoring with thermodilution which includes a new value to us ELWI (extra vascular lung water index) which in practice can alert you to the presence of pulmonary oedema before it is picked up on x-ray and also whether it is from Cardiac failure (PVPI 1-3) or Respiratory failure (PVPI 3-6). [PVPI- pulmonary Vascular Permeability Index]

-using SVRI to determine our patients afterload and therefore optimizing pressor usage

-GEDI (Global END Diastolic Volume INDEX) which calculates preload using PICCO, as opposed to SVV PPV values which are derived from pulse contour analysis and are more reliable in OT at tidal volumes of 8ml/kg.

GEDI normal range is which can then be used as a guide for fluid administration.

We also learnt that Proact (pulse contour analysis) can be applied in VV ECMO, and PICCO to IABP patients.

-there’s so much more, video link of the recording coming soon.

We started the day with registration where members from the multidisciplinary team got to network a little from hospitals around the KZN region (JJ&J practicing hospitals), namely,  Netcare St. Augustine’s, Pietermaritzburg Mediclinic, Midlands Medical Centre, Netcare St. Anne’s and Life Hilton.

We then had our first talk by JJ&J’s own, Clinical programs co-ordinator, ICU RN René Gomes who refreshed everyone on Cardiac Output theory.

After tea we had Arthur’s physiology talk….

The group also particularly enjoyed the interactive practical case quiz that Arthur presented, where we had to apply what we had learned against the clock! This made us really think!

We had to integrate our patients signs with all the variables from the cardiac output monitoring to make better clinical decisions. See the below tool:

We had a lovely 3 course lunch and answered a few more questions before calling it a very full, informative day! We left feeling empowered to provide even better care using this wonderful technology to our patient’s benefit 🙂

A big thank you to Christian Sibanda from Surgical Innovations for co-hosting the event with us and all the support he has rendered over the last year, as well as to Arthur from Getinge for coming all the way from the Netherlands to share his expertise. And a last shout out to 3J media for covering another successful event with JJ&J 🙂