Individualized Cardiac Index–Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial

Saugel, B; Meidert, AS; Meyhoff, CS; Sort, R; Aasvang, EK; Bergholz, A; Serir, A; Schwartze, E; Thomsen, KK; Zöllner, C; Berthold, S; Borrmann, M; Esser, J; Laska, A; Scheiermann, P; Foss, NB; Olsen, JW; Madsen, LM; Welling, AH; Gaik, C; Roth, S; Schröder, J; Vives, M; Klimovic, A; Eichlseder, M; Goldmann, S; Renné, T; Hedrich, H; Vettorazzi, E; Zapf, A; Kouz, K; Flick, M; PELICAN Trial Group

doi:10.1001/jama.2026.18574

Individualized Cardiac Index–Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial

JAMAPublished 19 Oct 2026multicenter, single-blind, superiority randomized clinical trial

Primary result · Composite of acute kidney injury, acute myocardial injury, severe infectious complications, nonfatal cardiac arrest, or deathResultRelative risk 0.94 95.1% CI 0.83–1.08

Read the original article ↗PubMed

Cite

Authors' conclusion

Among high-risk patients undergoing elective major abdominal surgery, individualized cardiac index-guided hemodynamic therapy targeting the patient’s preoperative resting cardiac index did not reduce the incidence of a composite outcome of acute kidney injury, acute myocardial injury, severe infectious complications, nonfatal cardiac arrest, or death within the first 7 postoperative days compared with routine hemodynamic therapy.

Study context

Population: High-risk patients undergoing elective major abdominal surgery at 12 university medical centers in Austria, the Czech Republic, Denmark, Germany, and Spain, between October 8, 2023, and October 25, 2025included in the primary analysis, 1128 enrolled, 1111 randomized
Participants: 1,095 patients

Comparison: Individualized cardiac index-guided hemodynamic therapy vs routine hemodynamic therapy
Individualized cardiac index-guided hemodynamic therapyn = 549
Routine hemodynamic therapyn = 546reference
Primary endpoint: Composite of:
Acute kidney injury
Acute myocardial injury
Severe infectious complications
Nonfatal cardiac arrest
Death
Follow-up: Within the first 7 postoperative days

Primary result

As reported in the abstract

Relative risk

0.94

95.1% CI 0.83–1.08

P = 0.38

Events by treatment group

Individualized cardiac index-guided hemodynamic therapy44.3%243 of 549 of 549

Routine hemodynamic therapy46.9%256 of 546 of 546

Individualized cardiac index-guided hemodynamic therapy vs routine hemodynamic therapy

relative risk 0.94 (95.1% CI 0.83–1.08); P = 0.38

Secondary outcomes

Individual components of the primary outcome · within the first 7 postoperative days

There were no between-group differences

Baseline characteristics

Median age: 67 years [IQR, 59-74 years]
Female: 49.4%

Reference

Authors: Saugel B, Meidert AS, Meyhoff CS, Sort R, Aasvang EK, Bergholz A, et al.
All 33 authors
Saugel B, Meidert AS, Meyhoff CS, Sort R, Aasvang EK, Bergholz A, Serir A, Schwartze E, Thomsen KK, Zöllner C, Berthold S, Borrmann M, Esser J, Laska A, Scheiermann P, Foss NB, Olsen JW, Madsen LM, Welling AH, Gaik C, Roth S, Schröder J, Vives M, Klimovic A, Eichlseder M, Goldmann S, Renné T, Hedrich H, Vettorazzi E, Zapf A, Kouz K, Flick M, PELICAN Trial Group
Journal: JAMA
Published: 19 Oct 2026
DOI: 10.1001/jama.2026.18574
PubMed: 42896534
Registration: NCT05648279

Topic: Haemodynamics, fluids & transfusion

Intervention details

individualized cardiac index-guided hemodynamic therapy: targeting the patient’s preoperative resting cardiac index
routine hemodynamic therapy: with blinded cardiac index monitoring

Original publication

Individualized Cardiac Index–Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial. JAMA. Published 19 October 2026. doi:10.1001/jama.2026.18574

Read the original article ↗

Composed by AI from the published abstract and checked against it. How Briefs are made →