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. 2019 Aug 28;8(9):1331. doi: 10.3390/jcm8091331

Table 2.

Summary of the most important studies describing the role pulmonary artery catheters.

Author, Reference Number, and the Year of Publication Number of Patients and the Time of Observation Primary Condition Diagnosed/Treated Results and Main Findings
Connors [76], 1996
“SUPPORT”		 5735 pts, 180 days Severe illness.
RHC group versus no RHC group: Acute respiratory failure:
589 (27%) versus 1200 (34%)
Multiorgan system failure:
1235 (57%) versus 1245 (35%)
Congestive heart failure:
209 (10%) versus 247 (7%)
Other:
151 (7%) versus 859 (24%)
  • 1.

    Patients with RHC had an increased 30-day mortality (odds ratio, 1.24; 95% confidence interval, 1.03–1.49);

  • 2.

    The mean cost (25th, 50th, 75th percentiles) per hospital stay was $49 300 ($17,000, $30,500, $56,600) with RHC and $35,700 ($11,300, $20,600, $39,200) without RHC;

  • 3.

    Mean length of stay in the ICU was 14.8 (5, 9, 17) days with RHC and 13.0 (4, 7, 14) days without RHC;

  • 4.

    Conclusions: After adjustment for treatment selection bias, RHC was associated with increased mortality and increased utilization of resources.
Wheeler [77], 2006 1000 pts, 60 days Acute lung injury (ALI)
  • 5.

    Patients randomized into PAC versus CVC guided therapy;

  • 6.

    The rates of death during the first 60 days before discharge home were similar in the PAC and CVC groups (27.4% and 26.3%, respectively; p = 0.69);

  • 7.

    Complications were uncommon and were reported at similar rates in each group: 0.08 ± 0.01 per catheter inserted in the PAC group and 0.06 ± 0.01 per catheter inserted in the CVC group (p = 0.35);

  • 8.

    Conclusions: The routine use of PAC in the ALI group of pts is discouraged.
Harvey [78], 2005
“PAC-Man”		 1014 pts, 90 days Acute respiratory failure (13%), Multiorgan dysfunction (65–66%),
Decompensated heart failure (11%), Other (10–11%)
  • 9.

    No difference in hospital mortality between patients managed with or without a PAC (68% (346 of 506) versus 66% (333 of 507), p = 0.39);

  • 10.

    No clear evidence of benefit or harm by managing critically ill patients with a PAC;

  • 11.

    Nearly 10% of pts in the PAC arm suffered from the complications (none of these were fatal).
Ramsey [82], 2004 13,907 pts, 7–8 days Aortocoronary bypass for heart revascularization—any type
  • 12.

    The relative risk of in-hospital mortality was 2.10 for the PAC group compared with the patients who did not receive a PAC (95% confidence interval (CI), 1.40 to 3.14; p < 0.001);

  • 13.

    The mortality risk was significantly higher in hospitals with the lowest third of PAC use (odds ratio, 3.35; 95% Cl, 1.74 to 6.47; p < 0.001);

  • 14.

    Not significantly increased in the highest two thirds of users (odds ratio, 1.62; 95% Cl, 0.99 to 2.66; p = 0.09);

  • 15.

    Days spent in critical care were similar, although total length of hospital stay was 0.26 days longer in the PAC group (p < 0.001);

  • 16.

    Hospital costs were $1402 higher in the PAC group.
Binanay [85], 2005
“ESCAPE”		 433 pts, 180 days Severe symptomatic heart failure despite recommended therapies
  • 17.

    The use of the PAC did not significantly affect the primary end point of days alive and out of the hospital during the first six months (133 days versus 135 days; hazard ratio (HR), 1.00 (95% confidence interval (CI), 0.82–1.21); p = 0.99);

  • 18.

    Mortality (43 patients (10%) versus 38 patients (9%); odds ratio (OR), 1.26 (95% CI, 0.78–2.03); p = 0.35), or the number of days hospitalized (8.7 versus 8.3; HR, 1.04 (95% CI, 0.86–1.27); p = 0.67);

  • 19.

    In-hospital adverse events were more common among patients in the PAC group (47 (21.9%) versus 25 (11.5%); p = 0.04);

  • 20.

    There were no deaths related to PAC use;

  • 21.

    No difference for in-hospital plus 30-day mortality (10 (4.7%) versus 11 (5.0%); OR, 0.97 (95% CI, 0.38–2.22); p = 0.97);
Sionis [86], 2019
“CardSchock”		 219 pts, 82 (37.4%) received PAC, 30 days Patients with cardiogenic shock included in the CardShock Study
  • 22.

    Cardiogenic shock patients who managed with a PAC received more frequent treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (p < 0.01);

  • 23.

    Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 (0.59–2.32), p = 0.66).
Doshi [87], 2018 6,645,363 pts, in hospital stay between 3–17 days HFrEF—3,225,529 hospitalizations HFpEF—3,419,834 hospitalizations
  • 24.

    Per 1000 hospitalizations, the use of PAC declined from 2005 to 2010 in both HFrEF (12.9 to 7.9, p < 0.001) and HFpEF (12.9 to 5.5, p < 0.001);

  • 25.

    From 2010 to 2014, the use of PAC per 1000 hospitalizations increased in both HFrEF (7.9 to 9.7, p < 0.001) and HFpEF (5.5 to 6.7, p < 0.001);

  • 26.

    The temporal decline in risk-adjusted mortality during the study period for HFrEF (odds ratio, 3.93 in 2005–2006 to 2.7 in 2013–2014, p < 0.001) and HFpEF (odd ratio, 2.72 in 2005–2006 to 2.62 in 2013–2014, p < 0.001);

  • 27.

    The length of stay and cost were significantly higher with PAC use in both HFrEF and HFpEF.
Hernandez [88], 2019 9,431,944 pts, in hospital stay between 2–20 days HF (n = 8,516,528) index manifestation
CS (n = 915,416) developed during the index hospitalization
  • 28.

    Overall, patients with PAC had increased hospital costs, length of stay, and mechanical circulatory support use;

  • 29.

    In patients with HF, PAC use was associated with higher mortality (9.9% versus 3.3% OR 3.96 p < 0.001);

  • 30.

    In those with CS, PAC was associated with lower mortality (35.1% versus 39.2% OR 0.91 p < 0.001);

  • 31.

    And lower in-hospital cardiac arrest (14.9% versus 18.3% OR 0.77 p < 0.001);

  • 32.

    This paradox persisted after propensity score matching.
Tehrani [89], 2019 204 consecutive pts, 30-day survival CS
  • 33.

    Compared with a 30-day survival of 47% in 2016, the 30-day survival in 2017 and 2018 increased to 57.9% and 76.6%, respectively (p < 0.01);

  • 34.

    Independent predictors of 30-day mortality were age ≥ 71 years, diabetes mellitus, dialysis, ≥36 h of vasopressor use at time of diagnosis, lactate levels ≥ 3.0 mg/dL, CPO < 0.6 W, and PAPi < 1.0 at 24 h after diagnosis and the implementation of therapies;

  • 35.

    Either 1 or 2 points were assigned to each variable, and a three-category risk score was determined: 0 to 1 (low), 2 to 4 (moderate), and ≥5 (high);

  • 36.

    Conclusions: A standardized team-based approach may improve CS outcomes;

  • 37.

    A score incorporating demographic, laboratory, and hemodynamic data may be used to quantify risk and guide clinical decision-making for all phenotypes of CS.

Table legend: PAC—pulmonary artery catheter, CVC—central venous catheter, ALI—Acute Lung Injury, HR—Hazard ratio, OR—Odds ratio, CI—confidence interval, HFrEF/HFpEF—heart failure with reduced/preserved ejection fraction, CS—cardiogenic shock, CPO—cardiac power output, PAPi—pulmonary arterial pulsatility index.