Pulmonary Artery Catheter Use Neutral for Patient Outcomes
Pulmonary Artery Catheter
The use of a pulmonary artery catheter (PAC), a device used for more than 30 years to assess cardiovascular health and to help guide the treatment of critically ill patients, does not appear to improve outcomes nor confer added risks to patients. The finding came from a new meta-analysis conducted by the Duke Clinical Research Institute (DCRI) of data collected from 13 randomized clinical trials studying the device.
The researchers, who reported the results of their analysis in the Oct. 5, 2005, issue of the Journal of the American Medical Association (JAMA), concluded that PACs should not be used routinely in patients in intensive care units (ICU), patients with severe heart failure or patients undergoing surgery, until further studies can uncover any correlations between outcomes from the use of the device with specific treatments.
In using the device, physicians insert a catheter into the venous system around the heart to obtain information about a variety of hemodynamic parameters, such as filling pressures, pumping strength of the heart, saturation levels of oxygen in the blood and how much fluid is being retained. The procedure is usually performed at the bedside, and the catheter can be left in place for a number of days to provide constant monitoring. More than 1 million PAC procedures are performed each year in the U.S.
"The main question this study raises is where the use of PAC fits into the overall therapeutic plan for these patients," said cardiologist Monica Shah, M.D., first author of the paper. She led the team while at the DCRI before leaving Duke for Columbia University Medical Center. "The PAC is a diagnostic tool, like an x-ray or an electrocardiogram, and as such, we don't necessarily expect them to improve outcomes on their own.
"Our analysis showed that PAC doesn't improve outcome as a part of a therapeutic strategy," she continued. "Maybe the catheter could be helpful if, for example, it guided us in selecting the right medications. To date, those types of trials have not been conducted."
The researchers conducted the meta-analysis as a way of putting into perspective the results of another trial