Cardiac Output
Cardiac Output is a podcast on cardiothoracic anaesthesia and intensive care medicine. Dr Mike Charlesworth and Dr Calum Downes discuss the evidence, the controversies and the practicalities of modern practice.
Episodes
What Would You Do? Cognitive Bias in ECMO Decisions
Important note: every case in this episode is completely fictitious. The scenarios are teaching constructs, invented to illustrate patterns of clinical reasoning. No case describes a real patient, and any resemblance to any individual is entirely coincidental.
In ECMO, the hard part is almost never the cannulation. Putting cannulas in and troubleshooting hypoxia are learnable. What's hard is the d
Check the Tube. Then Check It Again.
Something a bit different this episode. We've spent this series on pumps and valves and circuits — today it's the airway, and the lung you're deliberately collapsing.
Mike and Calum work through thoracic and cardiac airway management: one-lung ventilation, the difficult double-lumen tube, the shared airway, and a couple of scenarios that will catch you out badly if you haven't thought about them f
TAVI for Residents: Evidence, Rapid Pacing and Sedation
Everybody asks how you anaesthetise a patient for a TAVI. The answer takes about four seconds: it's lidocaine into the groin. For more than 95% of our patients that is very nearly it — transfemoral, local anaesthetic, a little procedural sedation from a nurse, and they never meet an anaesthetist at all.
Which raises the obvious question: why do a whole episode on it? Because the fact that the anae
Empty, Not Vasoplegic: Aortic Stenosis After Surgery
It's two in the morning. Your patient had an aortic valve replacement this afternoon — good ventricle, off bypass without a fuss — and the noradrenaline has crept up again. Your general intensive care instinct says work out why they're vasoplegic and turn the pressors up. In this specific patient, that instinct is wrong. Nine times out of ten they aren't vasoplegic. They're empty.
In this episode
VV-ECMO for Residents: Candidacy, Runs and Oxygenators
Our first episode covered veno-venous ECMO the way it gets examined: sweep for CO₂, flow for oxygen, who qualifies, and how to read CESAR and EOLIA honestly. This episode is everything we didn't say — not the physiology, but the service. How ECMO got here, who actually says yes to a referral, and the things that genuinely shorten a run.
Please note: this reflects local Wythenshawe practice. Take t
You Can't Clamp a Torn Aorta: DHCA Explained
Here's the puzzle. Your patient has an acute type A dissection, so the ascending aorta is torn. To do cardiac surgery you need to cannulate the aorta and cross-clamp it — but the ascending aorta is both dissected and the thing you're about to operate on. So you can't cannulate it, and you can't clamp it. What do you do?
The answer is that you cool the patient right down and stop the circulation al
Think Aorta: Hypertensive Emergencies and Dissection
A thirty-five-year-old with chest pain, a bit sweaty, a bit anxious, and a blood pressure that's frankly high. In a lot of departments that patient gets a troponin, a D-dimer, possibly a label of anxiety — and goes home. If that pain was an acute type A dissection, they are not going to get better.
In this episode Mike and Calum work through hypertension and the acute aortic syndromes as they actu
Heart and Lung Transplants: The First 48 Hours in ICU
The operation is over. The new heart and lungs are in, and the patient has just arrived on the unit. This is where you actually earn your keep.
In this episode Mike and Calum work through the first forty-eight hours after a heart or lung transplant — and almost everything comes back to one structure: the right ventricle. This is the postoperative ICU half; the theatre half is the previous episode.
Heart and Lung Transplants: The Twelve Hours in Theatre
The phone goes at eleven at night. There's a donor heart, and it's coming here. In a few hours that organ is going into a patient who is, right now, sitting on a ward waiting for you.
In this episode Mike and Calum work through heart and lung transplantation from the listing call to the handover on the unit — the twelve hours in the middle. This is the theatre half; the postoperative ICU episode i
Cardiac Theatre for Residents: Vasoplegia, SAM and Pacing
Your noradrenaline is climbing, and climbing, and the pressure still won't hold. The tank's the right size and the pump is working — so what do you reach for next?
In this episode Mike and Calum get scrubbed for the theatre half of the cardiac topic: the problems that show up on the table rather than on the unit, and the ones that catch people out. This is the companion to the ICU episode on heart
Mechanical Circulatory Support in ICU: Cardiac Output, VA-ECMO and VADs
It's the middle of the night (again). Your post-op cardiac patient looks awful, and the nurse says the cardiac output's low. Do you reach for a number — or do you look at the patient?
In this episode Mike and Calum work through heart failure and mechanical circulatory support the way it actually plays out on a cardiothoracic ICU: how you know the output is low, what the devices really do, and how
VV-ECMO for Residents: Physiology, Evidence, Troubleshooting
It's three in the morning. Your patient is proned, paralysed, on 100% oxygen, and his P/F ratio is 70. Do you keep cranking the ventilator — or do you pick up the phone?
In this episode Mike and Calum work through veno-venous ECMO the way it actually gets used on an ICU: what it does, who it's for, and the things that catch people out at the bedside.
We cover the single most important idea in ECMO
