PELICAN Trial: Does Cardiac Index Guidance Help Surgery?
Clinicians frequently discuss the optimal intraoperative hemodynamic strategy for high-risk surgical cases. Specifically, applying cardiac index hemodynamic therapy aims to protect vital organs from hypoperfusion. However, whether personalizing these targets to a patient's baseline resting values improves clinical recovery has remained controversial. Therefore, the PELICAN randomized clinical trial addressed this critical clinical question directly.
Study Design and Patient Population
The PELICAN trial enrolled 1,128 high-risk surgical patients across 12 university medical centers in five European countries. Subsequently, researchers randomized 1,111 participants undergoing elective major abdominal surgery into two distinct groups. One cohort received individualized therapy targeting their preoperative resting cardiac index. Meanwhile, the control cohort received routine hemodynamic management alongside blinded cardiac index monitoring. Ultimately, the primary analysis evaluated 1,095 patients with a median age of 67 years.
Findings on Cardiac Index Hemodynamic Therapy
The primary outcome measured a composite of major postoperative complications within seven days after surgery. Specifically, these events included acute kidney injury, acute myocardial injury, severe infectious complications, nonfatal cardiac arrest, or death. Importantly, 44.3% of patients in the individualized therapy group experienced the primary outcome compared to 46.9% in the routine group. Consequently, the relative risk reached 0.94 with a p-value of 0.38, demonstrating no statistically significant benefit. Furthermore, investigators observed no difference between groups for any individual complication within the first week.
Clinical Implications for Perioperative Care
These robust findings suggest that targeting preoperative resting cardiac index values does not improve short-term postoperative outcomes. Many clinicians previously believed that tailoring flow parameters to individual baseline measurements would reduce organ damage. However, the trial demonstrates that routine clinical practice achieves comparable protective effects without complex individualized titration. In addition, routine hemodynamic protocols already prevent severe hypoperfusion effectively in modern surgical suites. Thus, anesthesiologists may not need continuous cardiac index titration to preoperative baselines for all high-risk abdominal procedures, which forms a core competency taught in programs covering fundamentals of anaesthesia.
Frequently Asked Questions
Q1: What did the PELICAN trial investigate?
The PELICAN trial tested whether targeting preoperative resting cardiac index during major abdominal surgery reduces postoperative complications compared to routine care.
Q2: Did individualized cardiac index targets reduce postoperative complications?
No, the study showed no significant difference in postoperative complications, organ injury, or seven-day mortality between both groups.
Q3: How do these results influence routine anesthesia practice?
These findings show that routine hemodynamic care is effective, meaning clinicians do not need continuous cardiac index titration to resting baselines.
References
- Saugel B et al. Individualized Cardiac Index-Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial. JAMA. 2026 Oct 19. doi: 10.1001/jama.2026.18574. PMID: 42896534.
- Flick M, Aasvang EK, Eichlseder M, et al. Personalized hemodynamic management targeting preoperative baseline cardiac index in high-risk patients having major abdominal surgery: rationale and design of the international multicenter randomized PELICAN trial. Trials. 2026;27(1):286.
- Pearse RM, Harrison DA, MacDonald N, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311(21):2181-2190.
