EJAEur J Anaesthesio/2023;40:1-26INFOGRAPHICGUIDELINESESAIC focused guideline for the use of cardiac biomarkersin perioperative risk evaluationGiovanna Lurati Buse*,Bernardo Bollen Pinto*,Fernando Abelha,Tom E.F.Abbott,Gareth Ackland,Arash Afshari,Stefan De Hert,Jean-Luc Fellahi,Laure Giossi,Peter Kavsak,Dan Longrois,Rene M'Pembele,Anthony Nucaro,Ekaterine Popova,Christian Puelacher,Toby Richards,Sebastian Roth,Mootii Sheka,Wojciech Szczeklik,Judith van Waes,Bernhard Walder and Michelle S.ChewBACKGROUND In recent years,there has been increasingRESULTS In a modified Delphi process,the task forcefocus on the use of cardiac biomarkers in patients undergo-defined 12 critical outcomes.The systematic literatureing noncardiac surgery.search resulted in over 25,000 hits,of which 115 full-textarticles formed the body of evidence for recommendationsAIMS The aim of this focused quidelinewas to provideupdatedguidance regarding the pre,post-and combined pre-andThe evidence appraisal indicated heterogeneity in the cer-postoperative use of cardiac troponin and B-type natriuretictainty of evidence across critical outcomes.Further,therewas relevant gradient in the certainty of evidence across thepeptides in adult patients undergoing noncardiac surgery.three scopes of application.Recommendations were issuedMETHODS The guidelines were prepared using Grading ofand if this was not possible due to limited evidence,clinicalRecommendations Assessment Development and Evalua-practice statements were produced.tion (GRADE)methodology.This included the definition ofcritical outcomes,a systematic literature search,appraisal ofCONCLUSION The ESAIC focused guidelines provide guid-ance on the perioperative use of cardiac troponin and B-typecertainty of evidence,evaluation of biomarker measurementin terms of the balance of desirable and undesirable effectsnatriuretic peptides in patients undergoing noncardiac surincluding clinical outcomes,resource use,health inequalitygery,for three different scopes of application.stakeholder acceptance,and implementation.The panelGRAPHICAL ABSTRACT http://links.lww.com/EJA/A845differentiated between three different scopes of applicaPublished online xx month 2023tions:cardiac biomarkers as prognostic factors,as toolsfor risk prediction,and for biomarker-enhanced managementstrategies.*Joint first authors.From the Department of Anaesthesiology,University Hospital Dusseldorf,Dusseldorf,Germany (GLB,RMP,AN,SR),Division of Anaesthesiology,Geneva UniversityHospitals (HUG),Geneva,Switzerland (BBP,MS,BW),Department of Anesthesiology,Centro Hospitalar Unive rsitario de Sao Joao,Porto,Portugal (FA),CardiovascularResearch and Development Center(UnICRISE),Department of Surgery and Physiology,Faculty of Medicine of the University of Porto,Porto,Portugal(FA),WilliamHarvey Research Institute,Queen Mary University of London,London,UK (TEA,GA),Department of Anaesthesia and Perioperative Medicine,Royal London Hospital,BartsHealth NHS Trust,London,UK(GA),Departmen
