For the first time ever in the UK, we are bringing ECMO to the streets of London, offering hope to patients in cardiac arrest. londonsairambulance.org.uk/n…

Delighted to share that ACCESS has been shortlisted for Team of the Year at the @NursingTimes Awards 2026! 🏆 A huge congratulations to our incredible team, whose dedication and expertise deliver life-saving critical care transfers across London every day. #NursingTimesAwards

🚑 3 years of ACCESS London Supporting critical care transfers across London and beyond 📷 130,000+ km travelled 📷 Supported by over 500 healthcare professionals #CriticalCare #NHS

🤓🫀We keep asking: “What’s the cardiac output?” But maybe the better question is: “How efficiently is the heart working?” In septic shock, we often focus on: Preload Cardiac output MAP But we forget something fundamental: 👉 The heart doesn’t work alone. 👉 It works against the arterial system. 1. The missing concept: Ventriculo–arterial coupling (LVAC) LVAC = interaction between: Ees → contractility Ea → arterial load 👉 Expressed as Ea / Ees This ratio reflects: How efficiently the heart converts energy into forward flow 2. What is “normal”? LVAC ≈ 0.5 → optimal efficiency LVAC ≈ 1 → maximal stroke work LVAC > 1 → uncoupling (inefficient system) But here’s the twist: 👉 In septic shock, LVAC is often >1 👉 Not just due to vasodilation—but also myocardial dysfunction 3. Why this matters clinically Two patients can have: Same MAP Same CO But completely different physiology: ✔ One → efficient coupling ❌ One → energy wasted, poor flow generation 4. The key insight Septic shock is NOT just: ❌ “low preload” ❌ “vasodilation” It is: 👉 A mismatch between heart and arterial system 5. Therapy changes the balance Fluids → may improve coupling (↓ LVAC) Norepinephrine → can improve OR worsen coupling Inotropes → target Ees Important: 👉 Increasing MAP ≠ improving flow 👉 Increasing pressure can worsen afterload 6. The most interesting part From the data: LVAC >1 can predict response to norepinephrine But improving LVAC ≠ guaranteed tissue perfusion and outcomes follow a U-shaped curve 👉 Both too high AND too low LVAC can be harmful 7. The limitation we must respect Even if you “optimize” LVAC: 👉 Microcirculation may still be impaired 👉 Lactate may still rise 👉 Shock may persist Because: Macro ≠ micro 🤓Final message We need to move from: ❌ “Fix the blood pressure” To: ✅ “Optimize the interaction between heart and vessels” LVAC doesn’t replace hemodynamics. It completes it. 📃Reference Caicedo Ruiz JD et al. Journal of Critical Care, 2026. doi.org/10.1016/j.jcrc.2026.…

🚨 ACCESS Mega Sim Day 🚨 High-fidelity, high-pressure, real-world simulation in action today with the ACCESS team. This isn’t routine ICU — it’s ICU in motion. 👏 Huge well done to everyone undertaking the sim today — pushing boundaries!

Totally amped to announce HR26 registration is open! Foundations Reimagined. Lets rake everyone’s game to another level!!! thinkingcriticalcare.com/202…

Today marked an important step forward in US resuscitation science! The Center for Resuscitation Medicine’s MMRC completed the first Helicopter EMS–facilitated extracorporeal cardiopulmonary resuscitation (ECPR) in the United States!

Thank you to BloomsBury ambulance station NHS alone with @ACCESS_London1 for all your help this year with #OperationChristmasPresent @Ldn_Ambulance You have helped so many children smile this Christmas ❤️#ThankYou #Christmas #Ambulance #tuesdayvibe #AccessLondon @NHSBartsHealth

(1/x) When you trying to decongest patients in the ICU, there are lots of drugs available... not just lasix Here are some tips for diuresing patients🧵 Furosemide - backbone of diuresis. Start at a higher than you think and back off if diuresis achieved. Metolazone (or other thiazides). Use when Na on the higher side as helps prevent distal Na resorption. You get more naturesis. Acetazolamide. Use to prevent metabolic alkalosis. Aids in decongestion. Spironolactone. Use to prevent K+ wasting and to achieve more natriuresis. 3% saline. Consider in diuretic resistant heart failure with hypochloremia.

“Physiology-Guided CPR” 🚨🚨🚨 The inclusion of “physiology-guided CPR” in the ERC resuscitation guidelines marks a significant milestone in progress. So here are my reflections on the journey we have undertaken and thoughts on the future directions #SPEAR 🧵