Mamoun

Critical Care / Resuscitation. Interested in Trauma, Damage Control & Extra-Corporeal Support. #FOAMed #HEMS #ECMO #ECLS #NHS - views my own.

[Mamoun @drmamoun01]

Launch Day!

Endovascular Cardiac Arrest Team (ECAT) @LDNairamb in collaboration with @NHSBartsHealth & @Ldn_Ambulance - #ECMO-CPR #Resuscitation

[London's Air Ambulance Charity @LDNairamb]

For the first time ever in the UK, we are bringing ECMO to the streets of London, offering hope to patients in cardiac arrest.

https://t.co/MbBtwIWuGd

[Mamoun @drmamoun01]

@DrNickDalmon @Dr_XYZ @wesstreeting New uniform was hideous, poorly sized, appalling quality, most unprofessional and a huge drain on local resources for alterations & process management at a time when most trusts are failing at most clinical metrics. Another suspicious procurement decision! Follow the 💷 trail!

[Natalie Kruit @nattiejpk]

What happens when you remove the hospital as the boundary?

Advanced, targeted interventions & diagnostics can be delivered in the field enhancing cardiac arrest care

Reframing resuscitation as precision critical care @cliffreid @PrecareSyd @SydneyHEMS

https://t.co/wGXuWN64mz

[Dr Amit Pawa💉🎙️ @amit_pawa]

I have changed my practice because of this gem!

If you think it’s worthy - please give it a RT & a like!

[Mamoun @drmamoun01]

@YukiKotani5 @iceman_ex Which is why it’s minimally effective (if at all) in hypovolaemic/under resuscitated patients.

[Mamoun @drmamoun01]

@Asiritrauma1 Well done! Tremendous impactful achievement.

[Mamoun @drmamoun01]

@IM_Crit_ @chungk1031 Baffled by such numbers, if remotely accurate, they reflect system failures at multiple tiers from prep and workflows through to personnel competence thresholds.

[Mamoun @drmamoun01]

@irenep671 Poor operational workflows, inefficiency and absence of financial incentive. In the NHS, staff are paid regardless of their productivity and accountability is variable.

[Mamoun @drmamoun01]

@Asiritrauma1 @ACCESS_London1 That’s v kind of you. Hope you’re all well

[Mamoun @drmamoun01]

Tough to operate with success in current #NHS environment, yet, ACCESS London do it 24/7 all year round. Thousands of patients conveyed on complex life support and given access to lifesaving procedures! Proud you @ACCESS_London1 Team https://t.co/0FdVnDZRaF…

[ACCESS London @ACCESS_London1]

🚑 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

[Mamoun @drmamoun01]

What a beautiful piece on clinical physiology in septic shock and various haemodynamic profiles 🫀

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🤓🫀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. https://t.co/1ZNMHqwBl4

[Mamoun @drmamoun01]

A macro-sim across entire system, over 60 staff participated incl. multpl sites of @NHSBartsHealth & high complexity transfer by @ACCESS_London1 Crit Care Retrieval Team in collaboration with @Ldn_Ambulance testing processes, individual and collective skills - This is readiness

[ACCESS London @ACCESS_London1]

🚨 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!

[Mamoun @drmamoun01]

@Asiritrauma1 @ThinkingCC @icmteaching I’ve given up on SSC guidelines many years ago! In an era of increasing appreciation of diversity of phenotypes and readily available PoC imaging / haemodynamics diagnostics, the harm of 30 ml/kg “for all” simply can’t be justified in most settings.

[Mamoun @drmamoun01]

@BBCNews @nikkijfox @NHSuk / clinician obligations stop at point of discharge letter / summary of clinical care. Employers should employ/contract an OH service for all else. Unless (failing) #NHS stops trying to be everything for everyone, current failing trajectory shall continue!

[Mamoun @drmamoun01]

@Heccles94 Our economy is in worst state for decades and our GDP per capita plateaued for 10yrs, public sector incl #NHS failing miserably yet someone is offended benefits’ recipients should be asked to do some work to contribute to society! The UK really is broken! #gotowork

[Mamoun @drmamoun01]

@ShivaniM_KC Not all, depends on study selection criteria and rigour.

[Mamoun @drmamoun01]

@MaddiWulfeckMD PAC too far in and likely has caused a pulmonary artery injury or similar and the pericardial appearance suggests a pericardial collection. Echo required prior to any further interference with line.

[Mamoun @drmamoun01]

Practicing or budding Resuscitationists and Critical Care Physicians - do not miss this conference! Best wishes @ThinkingCC & Co

[Philippe Rola @ThinkingCC]

Totally amped to announce HR26 registration is open! Foundations Reimagined. Lets rake everyone’s game to another level!!! https://t.co/OAOke4UlwM

[Mamoun @drmamoun01]

Congrats to our USA colleagues & #ECPR collaborators on the first Helicopter facilitated ECMO-CPR in the United States #Resuscitation #ECPR #ECMO

[Adam Gottula @laertezz]

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!

[Mamoun @drmamoun01]

@doctimcook @NHSuk I wish it were just the media Tim.

[Mamoun @drmamoun01]

@Arden_2210 3x7=21