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Another Nail in the Coffin for Pulmonary-Artery Catheters

But maybe not the final one

Pulmonary-artery catheters (PACs), in use for more than 35 years, were universally and enthusiastically embraced until doubts arose about their utility and safety. Numerous studies have addressed these concerns in the past, but virtually all have been found wanting. In a new multicenter study, researchers evaluated the risks and benefits of pulmonary-artery catheters in patients with acute respiratory distress syndrome (ARDS).

They randomized 1000 patients who had had ARDS for 48 hours or less to receive either a pulmonary-artery catheter or a central-venous catheter. Hemodynamic data obtained from the catheters were combined with clinical measures for use in a standardized management protocol.

Adherence to treatment protocols was high. The death rate at 60 days, the primary outcome measure, was similar in the pulmonary-artery catheter and central-venous catheter groups (27.4% and 26.3%, respectively), as was the number of ventilator-free days during the first 28 days (mean, 13.2 and 13.5, respectively). There was no difference between groups in number of days without organ failure. Complications, mostly dysrhythmias, were uncommon and occurred at the same frequency in the two groups.

An editorialist notes that this study provides validation for those who have challenged the use of pulmonary-artery catheters and states, "The bottom line with respect to PAC use is that it should no longer be part of the routine management of a number of conditions for which it has been widely used."

Comment: The other lesson from this study is that it can take many years for honest assessment of interventions, particularly when the interventions are adopted not only uncritically, but with enthusiasm. The appeal of pulmonary-artery catheters — that more information makes for better decisions — is understandable. However, as in so many other circumstances, the medical community rushed to embrace a new technology, then spent 35 years proving that it had erred.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine June 26, 2006

Citation(s):

The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006 May 25; 354:2213-24.

• Original article (Subscription may be required)
• Medline abstract (Free)

Shure D. Pulmonary-artery catheters — Peace at last? N Engl J Med 2006 May 25; 354:2273-4.

• Original article (Subscription may be required)
• Medline abstract (Free)