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Another Blow to Pulmonary-Artery Catheters

High-risk surgery patients who received pulmonary-artery catheters fared no better than patients who did not.

Authorities have debated the merits of pulmonary-artery (PA) catheters ever since results of a large observational study suggested that they might be associated with increased mortality (Journal Watch Oct 1 1996). Now, Canadian researchers present the results of a partially industry-sponsored, randomized trial in which the use of PA catheters was assessed in surgical patients.

The study involved 1994 high-risk patients (American Society of Anesthesiologists class III or IV; age, 60 or older) who were scheduled for major surgery. Half of the patients received PA catheters; measurements from the catheters were used to direct perioperative use of fluids, inotropes, vasodilators, and vasopressors. The other group of patients received standard care without PA catheters. In-hospital, 6-month, and 12-month mortality rates and median hospital lengths of stay were virtually identical in the 2 groups. The only difference in morbidity was a higher incidence of pulmonary embolism in the catheter group than in the standard-care group (8 vs. 0 events).

Comment: Although it's possible that a few surgical patients derive benefit from PA catheters, these results demonstrate that their routine use is not warranted for high-risk surgical patients. Of note, most of these patients underwent vascular or abdominal surgery, so the results might not be applicable to thoracic-surgery patients, who composed only 6% of the study cohort. The results also do not necessarily apply to critically ill, nonsurgical patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine January 17, 2003

Citation(s):

Sandham JD et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003 Jan 2; 348:5-14.

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