title: Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01203605. Date of registration: 15.09.2010.
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Tahania
authors.initials: T
authors.lastname: Ahmad
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Beilstein
authors.affiliation: Hospital Universitario Rio Hortega, Valladolid, Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Aldecoa
authors.affiliation: Unidade de Cuidados Intensivos Neurocríticos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Rui P
authors.initials: RP
authors.lastname: Moreno
authors.affiliation: University of Szeged, Szeged, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Molnár
authors.affiliation: Ljubljana University Medical Centre, Ljubljana, Slovenia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Novak-Jankovic
authors.affiliation: Triemli City Hospital of Zurich, Zurich, Switzerland.
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Hofer
authors.affiliation: Charité University, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
authors.affiliation: St. George's University of London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.|Adult Critical Care Unit, Royal London Hospital, London, E1 1BB UK.
authors.forename: Rupert M
authors.initials: RM
authors.lastname: Pearse
keywords: Cardiac output monitoring; Haemodynamic monitoring; Major surgery; Perioperative medicine