Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists

A survey including 33 specific questions was emailed to 2,500 randomly selected active members of the ASA and to active ESA members.Overall, 368 questionnaires were completed, 57.1% from ASA and 42.9% from ESA members. Cardiac output is monitored by only 34% of ASA and ESA respondents (P = 0.49) while central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents (P < 0.01). Specifically, the pulmonary artery catheter is being used much more frequently in the US than in Europe in the setup of high-risk surgery (85.1% vs. 55.3% respectively, P < 0.001). Clinical experience, blood pressure, central venous pressure, and urine output are the most widely indicators of volume expansion. Finally, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved.In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States.Mortality and morbidity related to anesthesiology have significantly decreased during the last decade, mainly due to improvements in patients' safety in general, as well as better risk stratification and better management. However, complications following major surgery are still a leading cause of perioperative morbidity and mortality [1,2]. High-risk surgical patients represent only about 10% of the overall anesthesiology procedures performed each year, and yet these patients account for over 80% of perioperative deaths [3]. This represents a substantial global public-health concern since it is estimated that 234 million major surgical procedures are performed worldwide each year including 40 millions in the US alone [4].Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome i