by
Robert Garment, Executive Editor | August 08, 2005
The patients were randomly assigned to either management with pulmonary artery catheters or without, with the timing of the insertion and subsequent clinical management of each patient left to the discretion of the treating physician. In addition, individual ICUs were given the option of using an alternative cardiac output monitoring device in control patients. All patients were followed until discharge from an acute hospital service.
The investigators found that in-hospital mortality was similar between the two groups, being 68% for those who received a pulmonary artery catheter compared with 66% for patients in the control group (p=0.39). Deaths in the ICU occurred among 60% of the pulmonary artery catheter arm, and 57% of controls (p=0.37).
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There were also no significant differences between the groups in in-hospital survival to 90 days, length of stay in the ICU and hospital, and organ-days of support among survivors and non-survivors.
Pulmonary artery catheter-related complications occurred in 46 of 486 patients (10%) in whom catheter insertion was attempted. Hematomas at the insertion site occurred in 17 patients, arterial punctures in 16, and arrhythmias requiring treatment within one hour of insertion occurred in 16; one of the arrhythmias was an episode of cardiac arrest.
Less frequent complications included pneumothorax in two patients, hemothorax in one, and lost insertion guidewires requiring retrieval from the femoral vein and inferior vena cava in two cases.
The authors noted that more sophisticated and less invasive (albeit unproven) diagnostic and monitoring technologies are becoming available that could obviate the need for pulmonary artery catheters.
"Although benefit might accrue from skilled use of pulmonary artery catheters, its declining popularity and thus decreased familiarity among medical and nursing staff mandates regular training to maintain the required skills," the study's authors wrote. "Efficacy studies are needed to ascertain optimum management protocols and to identify the groups of patients who could gain from management with a pulmonary artery catheter, which could otherwise become a redundant technology."
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