Treating patients across European Union borders: An international survey in light of the coronavirus disease-19 pandemic.

BACKGROUND: In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed. OBJECTIVES: Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources. DESIGN: A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC). SETTING: Survey via a web-based platform. PATIENTS: Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey. MEASUREMENTS AND MAIN RESULTS: Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey. Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation. CONCLUSION: Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems.

Addition of biomarker panel improves prediction performance of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator for cardiac risk assessment of elderly patients preparing for major non-cardiac surgery: a pilot study.

BACKGROUND: Number of elderly patients subjected to extensive surgical procedures in the presence of cardiovascular morbidities is increasing every year. Therefore, there is a need to make preoperative diagnostics more accurate. AIMS: To evaluate the usefulness of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator as a predictive tool in preoperative assessment of cardiovascular risk in elderly patients. METHODS: This prospective pilot study included 78 patients who were being prepared for extensive non-cardiac surgeries under general anaesthesia. Their data have been processed on the interactive ACS NSQIP calculator. Blood sampling has been performed 7 days prior to surgery, and serum has been separated. Clinical, novel, and experimental biomarkers [hsCRP, H-FABP, and Survivin (BIRC5)] have been measured in specialized laboratories. RESULTS: Mean age of included patients was 71.35 ± 6.89 years. In the case of heart complications and mortality prediction, hsCRP and ACS NSQIP showed the highest specificity and sensitivity with AUC, respectively, 0.869 and 0.813 for heart complications and 0.883 and 0.813 for mortality. When combined with individual biomarkers AUC of ACS NSQIP raised, but if we combined all three biomarkers with ACS NSQIP, AUC reached as much as 0.920 for heart complications and 0.939 for mortality. DISCUSSION: ACS NSQIP proved to reduce inaccuracy in preoperative assessment, but it cannot be used independently, which has already been proved by other authors. CONCLUSIONS: Our results indicate that ACS NSQIP represents an accurate tool for preoperative assessment of elderly patients, especially if combined with cardiac biomarkers.

The preoperative assessment of patients with valvular heart disease as a comorbidity.

In patients with valvular heart disease planned for any type of surgery preoperative evaluation and preparation are especially important for a successfull outcome of the surgery. Preoperative preparation and intraoperative treatment of patients with valvular heart disease are different de-Spending on the type of valvular disease: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation or mitral valve prolapse. In this paper we have outlined the criteria for evaluating the severity of valvular disease, given that the risk in surgery is proportional to the degree of valvular disease. Also, given that the risk in surgery is also directly proportional to the type and extent of non cardiac surgery, it will be presented recommendations for intraoperative monitoring, with the purpose of evaluating patient's hemodynamic state, as well as recommendations for perioperative treatment of hypotension, tachycardia, and other hemodynamic disturbances. In the paper we will separately discuss bacterial endocarditis profilaxys which can occur after the surgery of patients with valvular disease. Since the patients with valvular disease, and especially the ones with implanted prosthetic valve or heart arrhythmia, are usually on oral anticoagulation therapy, it will be given recommendations for treatment of patients on oral anticoagulation therapy as part of preoperative preparations.