A theoretical evaluation of cost-effectiveness of pulmonary artery catheters in patients undergoing coronary artery surgery

Abstract

HE INTRODUCTION OF the flow-guided pulmonary artery catheter (PAC) by Swan and Ganz’ in 1970 and its subsequent development have allowed clinicians to measure many variables relating to cardiac and hemodynamic function such as cardiac output, mixed venous oxygen saturation, right ventricular ejection fraction, and pulmonary and systemicvascular resistance. In the intervening 20 years, much has been learned about measurement techniques and complications, but the question of which patients, if any, benefit from use of a PAC has not been resolved satisfactorily. In the management of patients having coronary artery bypass (CABG) surgery, the PAC has not been shown to provide significant increased patient benefit compared to use of a central venous pressure (CVP) catheter, possibly because previous studies have not had adequate sample size to assess differences in outcome between the two strategies. The increasing costs of medical care have brought closer scrutiny of many aspects of monitoring, but cost-effectiveness of the PAC has yet to be demonstrated. The resulting controversy about the indications for use of the PAC still exists. An attempt to resolve the question of cost-effectiveness of the PAC is important not only because of the volume of CABG surgery and widespread use of the catheter, but also because of the technologic changes that are occurring in this aspect of monitoring. Recently, different adaptations of the PAC have been studied or released for use, including some that measure continuous cardiac output. Soon to be released is a catheter that will incorporate continuous cardiac output with continuous mixed venous oxygen saturation. These new advances will permit continuous on-line evaluation of vascular resistance, cardiac index, oxygen delivery and uptake, and other calculated variables. The