Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset

Tahania Ahmad, Christian M Beilstein, Cesar Aldecoa, Rui P Moreno, Zsolt Molnár, Vesna Novak-Jankovic, Christoph K Hofer, Michael Sander, Andrew Rhodes, Rupert M Pearse, Tahania Ahmad, Christian M Beilstein, Cesar Aldecoa, Rui P Moreno, Zsolt Molnár, Vesna Novak-Jankovic, Christoph K Hofer, Michael Sander, Andrew Rhodes, Rupert M Pearse

Abstract

Background: The use of cardiac output monitoring may improve patient outcomes after major surgery. However, little is known about the use of this technology across nations.

Methods: This is a secondary analysis of a previously published observational study. Patients aged 16 years and over undergoing major non-cardiac surgery in a 7-day period in April 2011 were included into this analysis. The objective is to describe prevalence and type of cardiac output monitoring used in major surgery in Europe.

Results: Included in the analysis were 12,170 patients from the surgical services of 426 hospitals in 28 European nations. One thousand four hundred and sixteen patients (11.6 %) were exposed to cardiac output monitoring, and 2343 patients (19.3 %) received a central venous catheter. Patients with higher American Society of Anesthesiologists (ASA) scores were more frequently exposed to cardiac output monitoring (ASA I and II, 643 patients [8.6 %]; ASA III-V, 768 patients [16.2 %]; p < 0.01) and central venous catheter (ASA I and II, 874 patients [11.8 %]; ASA III-V, 1463 patients [30.9 %]; p < 0.01). In elective surgery, 990 patients (10.8 %) were exposed to cardiac output monitoring, in urgent surgery 252 patients (11.7 %) and in emergency surgery 173 patients (19.8 %). A central venous catheter was used in 1514 patients (16.6 %) undergoing elective, in 480 patients (22.2 %) undergoing urgent and in 349 patients (39.9 %) undergoing emergency surgery. Nine hundred sixty patients (7.9 %) were monitored using arterial waveform analysis, 238 patients (2.0 %) using oesophageal Doppler ultrasound, 55 patients (0.5 %) using a pulmonary artery catheter and 44 patients (2.0 %) using other technologies. Across nations, cardiac output monitoring use varied from 0.0 % (0/249 patients) to 27.5 % (19/69 patients), whilst central venous catheter use varied from 5.6 % (7/125 patients) to 43.2 % (16/37 patients).

Conclusions: One in ten patients undergoing major surgery is exposed to cardiac output monitoring whilst one in five receives a central venous catheter. The use of both technologies varies widely across Europe.

Trial registration: ClinicalTrials.gov Identifier: NCT01203605. Date of registration: 15.09.2010.

Keywords: Cardiac output monitoring; Haemodynamic monitoring; Major surgery; Perioperative medicine.

Figures

Fig. 1
Fig. 1
Use of cardiac output monitoring and central venous catheter per urgency of surgery. Data displayed as percentage per urgency of surgery. AWF arterial waveform analysis, Doppler Doppler ultrasound, PAC pulmonary artery catheter, COM cardiac output monitoring, CVC central venous catheter
Fig. 2
Fig. 2
Use of cardiac output monitoring and central venous catheter overall and per surgical speciality. Data displayed as percentage overall/per surgical speciality. AWF arterial waveform analysis, Doppler Doppler ultrasound, PAC pulmonary artery catheter, COM cardiac output monitoring, CVC central venous catheter
Fig. 3
Fig. 3
Variation in use of cardiac output monitoring and central venous catheter in European nations. Data is presented in % of patients with any type of cardiac output monitoring (bar) and central venous catheter (black diamond) per nation. Only nations with more than ten recruited patients are included into this graph. UK United Kingdom

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