• Filippo Sanfilippo, Alberto Noto, Valentina Ajello, Blanca Martinez Lopez de Arroyabe, Tommaso Aloisio, Pietro Bertini, Michele Mondino, Simona Silvetti, Antonio Putaggio, Carlotta Continella, Marco Ranucci, Fabio Sangalli, Sabino Scolletta, and Gianluca Paternoster.
• University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy. Electronic address: filipposanfi@yahoo.it.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 1; 38 (9): 194119501941-1950.

ObjectiveWide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery.DesignA national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted.SettingThe study occurred in Italian cardiac surgery centers (n = 71).ParticipantsAnesthesiologists-intensivists were enrolled.InterventionsAnonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU).Measurements And Main ResultsA total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046).ConclusionVariability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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