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

Background: 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. Methods: 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. Results: 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%). Conclusions: 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.