Table 1.
Summary of clinical studies of PAC use
| Ref. | Year | Number of cases | Study design | Clinical settings | Significant findings |
|---|---|---|---|---|---|
| [41] | 1975 | 413 | Case series | Autopsy reports | TEV with PAC was 4.25 times more frequent than with central lines; impact on mortality not studied |
| [38] | 1979 | 116 | Prospective case series | Critically ill patients with shock, pulmonary edema, and hemodynamic instability postoperatively | 77% Arrhythmia without increased mortality or morbidity, 1.7% staphylococcal bacteremia, 1.7% subclavian DVT |
| [49] | 1981 | 60 | Incidence study | Critically ill patients | 48% PVC and 33% VT with one death |
| [40] | 1981 | 320 PAC in 219 patients | Prospective case series | Critically ill patients | 3% Major complications; only one death |
| [36] | 1983 | 528 PAC placements in 500 patients | Case series | All cases in one medical center | 24% Complications, with 4.4% serious ones; no deaths related to complications |
| [42] | 1983 | 36 | Prospective case series | Autopsy | 61% mural thrombosis; incidence increased with prolonged duration of catheter; no significant impact on clinical course |
| [46] | 1984 | 55 | Case series | Autopsy, patients with PAC within 1 month of death | 53% RH endocardial lesions, 7% infective endocarditis, with pulmonic valve (56%) and pulmonary artery (5%) being the most and least common sites, respectively |
| [48] | 1985 | 56 | Prospective case series | ICU patents with shock, ARDS and preoperative | 12.5% advanced ventricular arrhythmia; no treatment required |
| [37] | 1985 | 141 | Case series | Autopsy | PAC associated with higher rate of mural thrombi compared with central lines |
| [3] | 1987 | 3263 | Retrospective | Patients with acute myocardial infarction | Increased length of hospital stay associated with PAC use; no long-term benefit |
| [33] | 1988 | 88 (30/28/30) | RCT (PAC control versus supranormal DO2 versus CVP) | Preoperative high-risk surgical patients | PAC had no effect on outcome unless used to guide therapy |
| [47] | 1989 | 279 PAC | Prospective | ICU patients | 3% new RBBB |
| [14] | 1989 | 1094 (537/557) | Controlled prospective cohort | Elective coronary artery bypass graft | No significant difference in outcome between PAC and CVP groups |
| [4] | 1990 | 5841 | Retrospective, analysis of PAC registry | Patients with acute myocardial infarction | Higher in-hospital mortality in CHF patients; thought to be related to use of PAC in sicker patients |
| [17] | 1991 | 33 (16/17) | RCT (PAC versus no PAC) | Nonsignificant benefit in favor of not receiving PAC | |
| [43] | 1991 | 297 | Prospective, incidence study | Medical/surgical ICU | 22% local infection and 0.7% bacteremia; factors associated with high-risk catheter-related infection included skin colonization, IJ insertion, catheter placement >3 days and insertion in the OR |
| [28] | 1994 | 100 (50/50) | RCT (supra-normal DO2 versus normal DO2) | Severe circulatory shock without response to fluid challenge | Increase mortality in treatment group |
| [29] | 1995 | 762 (252/253/257) | RCT (control versus supranormal DO2 versus minimal SvO2) | Multicenter, high-risk surgical patients with hemorrhagic, septic ARDS and trauma | No difference in mortality, organ dysfunction, or length of stay |
| [45] | 1995 | 32442 | Retrospective chart review | OR and ICU | 0.03% PA rupture with 70% mortality rate |
| [39] | 1995 | 630 PAC placements in 118 patients | Retrospective analysis | Patients with aneurysmal subarachnoid hemorrhage | 13% catheter related sepsis, 2% CHF, 1.2% DVT, 1% pneumothorax; no PA rupture |
| [5] | 1996 | 2016 (1008/1008) | Prospective cohort, case matching analysis | Critically ill patients | Increased mortality, cost of care and length of ICU stay in PAC group |
| [22] | 1997 | 104 (51/53) | RCT (routine PAC versus clinically indicated PAC) | Low-risk elective abdominal vascular surgery | Routine PAC had no benefit in mortality or morbidity |
| [21] | 1998 | 120 (60/60) | RCT (PAC versus no PAC) | Surgical low-risk AAA repair | No benefit, possibly with higher intraoperative complications |
| [6] | 2000 | 10,217 | Retrospective database study | Nonoperative patients in medical and surgical ICU | Direct association of PAC use with admission in surgical ICU, white race, care given by nonintensivist, and having private insurance |
| [8] | 2001 | 4059 (221/3838) | Prospective, observational cohort | Elective major noncardiac surgery | Increase in cardiac and noncardiac events with PAC |
| [18] | 2003 | 1994 (997/997) | RCT (PAC versus no PAC) | High risk, >6-year-old surgical patients | No benefit in PAC group, higher PE in catheter group, survival rate favored non-PAC group |
| [20] | 2003 | 676 (335/341) | RCT (PAC versus no PAC) | Multicenter; shock and ARDS patients | No impact of PAC on mortality or morbidity |
| [23] | 2005 | 1041 (519/522) | RCT (PAC versus no PAC) | Multi-center, all adult ICUs | No evidence of benefit or hospital mortality, 10% complications but not fatal |
| [24] | 2005 | 433 (215/218) | RCT (PAC versus no PAC) | Multicenter, severely symptomatic CHF patients | No evidence of benefit or overall mortality, 5% complications but none fatal |
AAA, abdominal aortic aneurysm; ARDS, acute respiratory distress syndrome; CHF, congestive heart failure; CVP, central venous pressure; DO2, oxygen delivery; DVT, deep venous thrombosis; ICU, intensive care unit; IJ, internal jugular; MI, myocardial infarction; OR, operating room; PA, pulmonary artery; PAC, pulmonary artery catheter; PE, pulmonary embolism; RHC, right heart catheterization; RH, right heart; RBBB, right bundle branch block; RCT, randomized clinical trial; SvO2, mixed venous oxygen saturation; TEV, thrombotic endocardial vegetation; VT, ventricular tachycardia.