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Cardiac OutputPELICANNCT05648279

Personalized Hemodynamic Management in High-risk Major Abdominal Surgery

A study testing Personalized hemodynamic management in people with Cardiac Output and Surgery, run by Universitätsklinikum Hamburg-Eppendorf at 12 sites in 5 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Postoperative mortality within 30 days after surgery is around 2% in patients having major noncardiac surgery in Europe and the USA. In fact, if the first 30 days after surgery were considered a disease, it would be the third leading cause of death globally. Read more about this study

Who is it for?
Ages 45 years and older
What is being tested?
Personalized hemodynamic management
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,128 participants
Where
12 sitesin 5 countries
Study dates
8 Oct 2023to 15 Jan 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 45 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Consenting patients ≥45 years scheduled for elective major abdominal surgery (involving visceral organs) under general anesthesia that is expected to last ≥90 minutes AND presence of ≥1 of the following high-risk criteria:
  • exercise tolerance <4 metabolic equivalents as defined by the guidelines of the American College of Cardiology/American Heart Association
  • renal impairment (serum creatinine ≥1.3 mg dL-1 or estimated glomerular filtration rate <90 mL min-1 (1.73 m2)-1 within the last 6 months
  • coronary artery disease
  • chronic heart failure (New York Heart Association Functional Classification ≥II)
  • valvular heart disease (moderate or severe)
Show all 17Show fewer
  • history of stroke
  • peripheral arterial occlusive disease (any stage)
  • chronic obstructive pulmonary disease (any stage) or pulmonary fibrosis (any stage)
  • diabetes mellitus requiring oral hypoglycemic agent or insulin
  • immunodeficiency due to a disease (e.g., HIV, leukemia, multiple myeloma) or therapy (e.g., immunosuppressants, chemotherapy, radiation, steroids [above Cushing threshold])
  • liver cirrhosis (any Child-Pugh class)
  • body mass index ≥30 kg m-2
  • history of smoking within two years of surgery
  • age ≥65 years
  • expected surgery duration ≥180 minutes
  • B-type natriuretic peptide (BNP) >80 ng/L or N-terminal B-type natriuretic peptide (NT-proBNP) >200 ng/L within the last 6 months

Who cannot join

  • emergency surgery
  • ambulatory surgery
  • planned surgery: nephrectomy, liver or kidney transplantation surgery
  • status post transplantation of kidney, liver, heart, or lung
  • sepsis (according to current Sepsis-3 definition)
  • American Society of Anesthesiologists physical status classification V or VI
Show all 9Show fewer
  • pregnancy
  • impossibility to perform cardiac index monitoring using the Starling Fluid Management System (Baxter, Deerfield, IL, USA)
  • current participation in another clinical trial or treatment with a similar biological mechanism or primary outcome measure

Trial locations and contacts

12 sites in 5 countries.

12 sites in 5 countries

Germany6 sites
  • University Hospital RWTH Aachen

    Aachen

  • University Hospital Düsseldorf

    Düsseldorf

  • University Medical Center Hamburg

    Hamburg

  • University Medical Center Schleswig Holstein, Lübeck

    Lübeck

  • University Hospital Marburg

    Marburg

  • LMU Munich

    Munich

Other trials in Germany

Denmark3 sites
  • Hvidovre Hospital

    Copenhagen

  • Rigshospitalet

    Copenhagen

  • University Medical Center Copenhagen Bispebjerg and Frederiksberg

    Copenhagen

Other trials in Denmark

Austria1 site
  • Medical University of Graz

    Graz

Other trials in Austria

Czechia1 site
  • University Hospital Plzen

    Pilsen

Other trials in Czechia

Spain1 site
  • Clínica Universidad de Navarra

    Pamplona

Other trials in Spain

About this study

Official title: Personalized Hemodynamic Management Targeting Preoperative Baseline Cardiac Index in High-risk Patients Having Major Abdominal Surgery: the International Multicenter Randomized PELICAN Trial

Postoperative mortality within 30 days after surgery is around 2% in patients having major noncardiac surgery in Europe and the USA. In fact, if the first 30 days after surgery were considered a disease, it would be the third leading cause of death globally. Postoperative deaths are a consequence of postoperative organ injury and complications - including acute myocardial injury, acute kidney injury, and severe infectious complications. To avoid postoperative deaths, it is thus crucial to reduce postoperative organ injury and complications. To reduce postoperative organ injury and complications, modifiable risk factors need to be addressed. These modifiable risk factors for postoperative organ injury include low blood flow states and intraoperative hypotension. Optimizing blood flow (i.e., cardiac index) during surgery may thus be effective in reducing postoperative organ injury and complications. However, the optimal hemodynamic treatment strategy for high-risk surgical patients remains unclear. Cardiac index varies substantially between individuals. However, current intraoperative hemodynamic treatment strategies mainly aim to maximize cardiac index instead of using personalized cardiac index targets for each individual patient. A single-center pilot trial suggests that using individualized cardiac index targets during surgery may reduce postoperative organ injury and complications compared to routine hemodynamic management. However, large robust trials investigating the effect of personalized hemodynamic management targeting preoperative baseline cardiac index on postoperative complications are missing.

The investigators, therefore, propose a multicenter randomized trial to test the hypothesis that personalized intraoperative hemodynamic management targeting preoperative baseline cardiac index reduces the incidence of a composite outcome of acute kidney injury, acute myocardial injury, non-fatal cardiac arrest, severe infectious complications, and death within 7 days after surgery compared to routine hemodynamic management in high-risk patients having elective major abdominal surgery.

Read the detailed description

not provided

Being tested
Personalized hemodynamic management
Medical subject headings
Postoperative Complications

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Personalized hemodynamic managementOther

    Personalized hemodynamic management: Intraoperative cardiac index will be maintained at least at the preoperative baseline cardiac index. Preoperative baseline cardiac index will be determined one day before surgery with the patient being awake and resting in the supine position using the Starling Fluid Management System (Baxter, Deerfield, IL, USA) Preoperative baseline cardiac index will be determined with the patient being awake and resting in supine position using the Starling Fluid Management System (Baxter, Deerfield, IL, USA) (usually at least one day before surgery). We will define the individual preoperative baseline cardiac index as the average value over a 5 min period at rest (minimum cardiac index threshold: 2.2 L min-1 m-2). Intraoperative cardiac index will be measured using the Baxter Starling Fluid Management System.

Study groups in NCT05648279
Study groupRoleWhat they receive
Routine hemodynamic management (control)No interventionIn patients assigned to routine hemodynamic management, hemodynamic management will performed as per anesthesiologist preference. Cardiac index monitoring will be will measured using the Baxter Starling Fluid Management System (Baxter, Deerfield, IL, USA). The attending anesthesiologist will be blinded to cardiac index measurements. Cardiac index monitoring can be unblinded upon request. Mean arterial blood pressure will be maintained above 65 mmHg.
Personalized hemodynamic management (intervention)ExperimentalIn patients assigned to personalized hemodynamic management, intraoperative cardiac index will be maintained at least at the preoperative baseline cardiac index using a predefined treatment algorithm. Preoperative baseline cardiac index will be determined with the patient being awake and resting in supine position using the Starling Fluid Management System (Baxter, Deerfield, IL, USA) (usually at least one day before surgery). We will define the individual preoperative baseline cardiac index as the average value over a 5 min period at rest (minimum cardiac index threshold: 2.2 L min-1 m-2). Mean arterial blood pressure will be maintained above 65 mmHg. The study intervention will start at the beginning of surgery and will end at the end of surgery.
Receives: Other: Personalized hemodynamic management

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Composite outcome of major postoperative complications

    Collapsed composite ("any event versus none") of acute kidney injury, acute myocardial injury (including myocardial infarction), non-fatal cardiac arrest, severe infectious complications, and death within 7 days after surgery.

    Measured: Postoperative Day 7

Secondary outcomes (34)
  1. Composite outcome of major postoperative complications

    Collapsed incidence of acute kidney injury, acute myocardial injury (including myocardial infarction), non-fatal cardiac arrest, severe infectious complications, and death within 3 days after surgery.

    Measured: Postoperative Day 3

  2. Postoperative acute kidney injury

    Incidence of acute kidney injury within 3 days after surgery

    Measured: Postoperative Day 3

  3. Postoperative acute kidney injury

    Incidence of acute kidney injury within 7 days after surgery

    Measured: Postoperative Day 7

  4. Postoperative acute myocardial injury

    Incidence of acute myocardial injury within 3 days after surgery

    Measured: Postoperative Day 3

  5. Postoperative acute myocardial injury

    Incidence of acute myocardial injury within 7 days after surgery

    Measured: Postoperative Day 7

  6. Postoperative severe infectious complications

    Incidence of a composite outcome of fever, respiratory infection, neurological infection, urinary system infection, colitis or infection with Clostridium difficile, endometritis, surgical site infection, deep incisional surgical site infection, organ or space surgical site infection (including anastomotic leak), unknown infection with pathogenic organisms in tissue or fluid, and sepsis within 3 days after surgery.

    Measured: Postoperative Day 3

  7. Postoperative severe infectious complications

    Incidence of a composite outcome of fever, respiratory infection, neurological infection, urinary system infection, colitis or infection with Clostridium difficile, endometritis, surgical site infection, deep incisional surgical site infection, organ or space surgical site infection (including anastomotic leak), unknown infection with pathogenic organisms in tissue or fluid, and sepsis within 7 days after surgery.

    Measured: Postoperative Day 7

  8. Postoperative non-fatal cardiac arrest

    Incidence of postoperative non-fatal cardiac arrest within 3 days after surgery

    Measured: Postoperative Day 3

  9. Postoperative non-fatal cardiac arrest

    Incidence of postoperative non-fatal cardiac arrest within 7 days after surgery

    Measured: Postoperative Day 7

  10. Postoperative death

    Incidence of postoperative death within 3 days after surgery

    Measured: Postoperative Day 3

  11. Postoperative death

    Incidence of postoperative death within 7 days after surgery

    Measured: Postoperative Day 7

  12. Composite outcome of long-term postoperative complications

    Collapsed incidence of need for renal replacement therapy, myocardial infarction, non-fatal cardiac arrest, and death within 30 days after surgery

    Measured: Postoperative Day 30

  13. Composite outcome of long-term postoperative complications

    Collapsed incidence of need for renal replacement therapy, myocardial infarction, non-fatal cardiac arrest, and death within 90 days after surgery

    Measured: Postoperative Day 90

  14. Postoperative need for renal replacement therapy

    Incidence of need for renal replacement therapy within 30 days after surgery

    Measured: Postoperative Day 30

  15. Postoperative need for renal replacement therapy

    Incidence of need for renal replacement therapy within 90 days after surgery

    Measured: Postoperative Day 90

  16. Postoperative myocardial infarction

    Incidence of myocardial infarction within 30 days after surgery

    Measured: Postoperative Day 30

  17. Postoperative myocardial infarction

    Incidence of myocardial infarction within 90 days after surgery

    Measured: Postoperative Day 90

  18. Postoperative non-fatal cardiac arrest

    Incidence of non-fatal cardiac arrest within 30 days after surgery

    Measured: Postoperative Day 30

  19. Postoperative non-fatal cardiac arrest

    Incidence of non-fatal cardiac arrest within 90 days after surgery

    Measured: Postoperative Day 90

  20. Postoperative death

    Incidence of death within 30 days after surgery

    Measured: Postoperative Day 30

  21. Postoperative death

    Incidence of death within 90 days after surgery

    Measured: Postoperative Day 90

  22. Postoperative fever

    Incidence of fever within 7 days after surgery

    Measured: Postoperative Day 7

  23. Postoperative respiratory infection

    Incidence of respiratory infection within 7 days after surgery

    Measured: Postoperative Day 7

  24. Postoperative neurological infection

    Incidence of neurological infection within 7 days after surgery

    Measured: Postoperative Day 7

  25. Postoperative urinary system infection

    Incidence of urinary system infection within 7 days after surgery

    Measured: Postoperative Day 7

  26. Postoperative colitis or infection with Clostridium difficile

    Incidence of colitis or infection with Clostridium difficile within 7 days after surgery

    Measured: Postoperative Day 7

  27. Postoperative endometritis

    Incidence of endometritis within 7 days after surgery

    Measured: Postoperative Day 7

  28. Postoperative deep incisional surgical site infection

    Incidence of deep incisional surgical site infection within 7 days after surgery

    Measured: Postoperative Day 7

  29. Postoperative organ or space surgical site infection

    Incidence of organ or space surgical site infection (including anastomotic leak) within 7 days after surgery

    Measured: Postoperative Day 7

  30. Postoperative unknown infection with pathogenic organisms in tissue or fluid

    Incidence of unknown infection with pathogenic organisms in tissue or fluid within 7 days after surgery

    Measured: Postoperative Day 7

  31. Postoperative sepsis

    Incidence of sepsis within 7 days after surgery

    Measured: Postoperative Day 7

  32. Transfer from intensive care unit to normal ward

    Time-to-event endpoint with the event "transfer from intensive care unit to normal ward" within 90 days after surgery

    Measured: Postoperative Day 90

  33. Hospital discharge

    Time-to-event endpoint with the event "hospital discharge" within 90 days after surgery

    Measured: Postoperative Day 90

  34. Unplanned hospital re-admission

    Incidence of unplanned hospital re-admission within 30 days after surgery

    Measured: Postoperative Day 30

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Dec 2022
  2. Study start8 Oct 2023
  3. Primary completion25 Oct 2025
  4. Study completion15 Jan 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
1,128 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05648279
Sponsor's protocol ID
2022-100955-BO-ff
Acronym
PELICAN
Status last verified
Feb 2026
First submitted
5 Dec 2022
Last updated
5 Feb 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Publications

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

    PubMed 42896534
  • Flick M, Aasvang EK, Eichlseder M, Klimovic A, Meidert AS, Meyhoff CS, Roth S, Steinhaus M, Sort R, Vives M, Vojnar B, Ziemann S, Krause L, Vettorazzi E, Zapf A, Kouz K, Saugel B. 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 Mar 28;27(1):286. doi: 10.1186/s13063-026-09657-9.

    PubMed 41904483

Questions about this trial

What is this clinical trial studying?

A study testing Personalized hemodynamic management in people with Cardiac Output and Surgery, run by Universitätsklinikum Hamburg-Eppendorf at 12 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 12 sites in Germany, Denmark, Austria, Czechia, Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Composite outcome of major postoperative complications (time frame: Postoperative Day 7). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05648279, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Feb 2026.

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