# Access to haemodynamic evaluation tools in middle-income countries: a survey of 1593 anaesthetists and intensivists from 39 nations

## TL;DR

A survey of over 1500 anaesthetists and intensivists in middle-income countries reveals limited access to critical haemodynamic tools, highlighting a global healthcare equity gap.

## Contribution

This study quantifies access disparities to haemodynamic monitoring tools in middle-income countries through a large-scale survey of clinical professionals.

## Key findings

- Most respondents had access to central venous catheters and arterial pressure monitoring but limited access to echocardiography and cardiac output monitoring.
- Cost of monitors and disposable sensors were the main barriers to cardiac output monitoring access.
- Over 70% of respondents indicated they would use cardiac output monitoring more if costs were reduced.

## Abstract

Approximately 75% of the world’s population lives in middle-income countries (MICs), where access to haemodynamic evaluation tools may be limited, exacerbating global healthcare disparities.

We conducted an online survey of anaesthetists and intensivists working in MICs, inviting them to complete 15 questions on bedside haemodynamic evaluations and access to haemodynamic monitoring tools.

We analysed 1593 valid questionnaires from 20 Upper and 19 Lower MICs. Most respondents (66%) worked in academic hospitals, 43% in private hospitals, and 20% in non-academic public hospitals. Respondents worked in ICUs (39%), operating rooms (38%), or both (23%). Nearly all had access to central venous catheters (99%) and invasive radial arterial pressure monitoring (91%). Fewer than two-thirds (63%) reported access to echocardiography, and only 37% had access to cardiac output monitoring systems when needed. The main barriers were the cost of monitors (54%) and the cost of disposable sensors (52%). Notably, 72% indicated they would use cardiac output monitoring equipment more frequently if costs were reduced. Most respondents (89%) reported a routine practice of predicting fluid responsiveness before giving a fluid bolus, most commonly with pulse pressure variation (64%) or ultrasound indices (55%). Tissue perfusion was mainly assessed by clinical evaluation (86%), blood lactate (81%), and capillary refill time (63%).

In MICs, less than two-thirds of anaesthetists and intensivists reported having access to echocardiography for haemodynamic assessment. Fewer than 40% have access to cardiac output monitoring systems, mainly attributable to economic constraints. As this report represents a potential concerning equity gap in global healthcare, efforts should be made to prioritise and facilitate access to haemodynamic evaluation tools in MICs.