Cardiac anaesthesia

New challenges and frontiers

Technological advances in cardiac anaesthesia and expanding roles for clinicians are rapidly reshaping the way we care for our most vulnerable patients. From navigating the challenges of working in the Cath lab to the intricate complexity of ECMO, today’s cardiac anaesthetist must adapt to an everevolving landscape. 

In this special symposium, organised in collaboration with the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC), we’ll hear from experts tackling four pivotal frontiers: the unique challenges of anaesthetising patients in the catheterisation laboratory; leveraging echocardiography to guide and optimise weaning from venoarterial ECMO; broadening the lifesaving reach of ECMO with new indications and practical insights; and finally, debating whether Enhanced Recovery After Cardiac Surgery (ERACS) should be the universal standard or a tailored strategy for select patients.  

The catheterisation laboratory is a uniquely complex environment for anaesthetists. Congested working spaces, limitations in equipment and medication, and gaps in monitoring demand extra levels of adaptability when managing high-risk patients. Dr. Chirojit Mukherjee, Chairman of the Department of Anesthesia & Intensive care at HELIOS Heart Hospital, Karlsruhe, Germany, will explore some of the many challenges faced by anaesthetists while working in the Cath Lab.  

Anaesthetists must work closely with cardiologists, radiographers, and nurses, so skills in effective interdisciplinary communication are vital, especially in an emergency. They must also be prepared for sudden hemodynamic changes and airway emergencies, while whilst not being in an advantageous position to initiate emergency care. Emergency preparation in a non-operating room environment can increase the risk of errors and anaesthetists must balance patient care by minimising their own exposure when working with fluoroscopy. This means they must display flexibility and plan an intensive, patient tailored and patient-centric approach to ensure patient safety. Dr Mukherjee will discuss these challenges and propose unique solutions to ensure effective and safe treatment.  

In cardiac anaesthesia, extracorporeal membrane oxygenation (ECMO) has shifted from a last‑ditch rescue to a proactive support tool for high‑risk cases. Venoarterial (VA) ECMO now underpins complex valve repairs, heart–lung transplants and refractory right‑ventricular failure, while ECPR stabilises patients during cardiogenic shock or intraoperative arrest. It’s even used pre-emptively in procedures like TAVI when rapid surgical conversion is possible. 

Weaning from venoarterial ECMO is a critical step that requires a careful assessment of native cardiac function. In this presentation, Dr. Fabio Guarracino, a leading expert in the field of “acute” echocardiography, will show us how echocardiography plays a central role in this process, providing real-time, non-invasive insights into ventricular recovery and overall hemodynamic performance. Key echocardiographic parameters, such as left ventricular ejection fraction (LVEF), aortic velocity-time integral (VTI), and right ventricular function, guide clinicians in evaluating whether the heart can sustain adequate output without mechanical support. 

While transthoracic echocardiography is always the first-line approach, transesophageal echocardiography (TEE) is especially valuable in patients with suboptimal transthoracic windows. By integrating echocardiographic findings with clinical and hemodynamic data, clinicians can optimise timing and increase the safety of weaning, reducing the risk of premature decannulation and ensuring better outcomes. 

Advances in ECMO require a more refined multidisciplinary approach. Anaesthesia teams, perfusionists, and ICU colleagues must work in tighter collaboration and adopt a much deeper understanding of ECMO physiology and management. Professor Gudrun Kunst, a Consultant Anaesthetist at King’s College Hospital and Honorary Professor of Cardiovascular Anaesthesia at King’s College London will discuss how such advances demand multidisciplinary teams become fluent in anticoagulation, circuit management and tailored ventilation. She will demonstrate how ongoing trials are refining best practices, securing ECMO’s place in the cardiac anaesthesia toolkit. 

Although the concept of Enhanced Recovery After Surgery (ERAS) was originally developed for colorectal surgery, in recent years it has been increasingly adapted for cardiac surgery. 

Prof Dr Steffen Rex, an Associate Professor from the Department of Cardiovascular Sciences at the Catholic University Leuven, Belgium, will propose that if the infrastructure is available, ERACS should be the standard of care for all patients. ERACS is also effective in improving outcomes in complex patients, especially the elderly, who can benefit enormously. He will show how super individualisation is not necessary. Utilising a standardised approach would be very effective, with only small adjustments for each patient. What is his message from 10 years of experience? Keep it simple to keep it effective. Don’t overcomplicate things. He also points out that physicians can help themselves and the patients by adopting a more flexible mindset in their practice and they should be on guard to becoming stuck in fixed approaches to patient care.  

We delved into how these advancements had reshaped our practice, improved patient safety, and laid the groundwork for the future of cardiac anaesthesia. “Cardiac anaesthesia: new challenges and frontiers” was held on 25th May 2025, from 13:15 to 14:15 WEST in room Faro.