ESA: 65% of anesthesiologists fail to monitor cardiac output in surgery

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University of California, Irvine researchers are calling for international action after results from a recent study indicated that only 35 percent of anesthesiologists surveyed are monitoring cardiac output in patients undergoing high-risk surgery, according to findings presented June 12 at the European Anaesthesiology Congress. Study authors said the measure can significantly impact patient recovery.

Maxime Cannesson, MD, PhD, associate professor of clinical anesthesiology at the University of California, Irvine, and colleagues sent an email survey of 30 questions to 2,500 randomly selected members of the European Society of Anaesthesiologists (ESA) and the American Society of Anesthesiology (ASA).

Of the 462 responses received, 30 percent from the ESA have protocols for hemodynamic management of patients undergoing high-risk surgery, while only 5 percent from the ASA do. Despite those figures, 95 percent of respondents claimed they knew it was important that enough oxygen reached all parts of the body during an operation and that this was determined by how well the heart was pumping blood around the body.

“Several studies have shown that when anesthesiologists measure and then set goals for cardiac output monitoring during high-risk surgery, their patients will have fewer postoperative complications, a shorter stay in the hospital after the surgery and fewer of them will die in the postoperative period,” said Cannesson. “The idea is very simple: since oxygen is of major importance to the body when it is experiencing stress, as in the case of high-risk surgery, it seems logical that setting goals for maximizing the delivery of oxygen to the tissues would improve patients’ care.”

Examples of high-risk surgery include operations performed on the liver, pancreas and aorta, as well as cancer surgery and orthopedic surgery. High-risk surgeries represent about 10 to 14 percent of all surgeries performed globally, the study authors reported.

According to survey respondents, the main reasons for not monitoring included the CO monitors were too invasive, the anesthesiologists were using a surrogate for CO monitoring, such as checking for variations in pulse pressure, or they believed CO monitoring didn’t provide important information.

“Our study shows that there is a need for action by national and international professional societies to ensure that cardiac output monitoring is used in clinical practices for these patients. There should be a European and U.S. task force that comes up with recommendations regarding all hemodynamic monitoring during surgery in order to improve the care of patients,” said Cannesson.