Pulmonary Artery Catheter Use During Cardiac Surgery in the United States, 2010 to 2014

Abstract

To examine patterns of use of pulmonary artery catheters in a large cohort of patients undergoing cardiac surgery. A retrospective study with univariate and multivariate logistic regression to identify independent predictors for the utilization of pulmonary artery catheters. University, small, medium and large community hospitals participating in the National Anesthesia Clinical Outcomes Registry. A total of 116,333 patients undergoing pulmonary artery catheter placement during cardiac surgery in the National Anesthesia Clinical Outcomes Registry from the Anesthesia Quality Institute. Age older than 50 years, American Society of Anesthesiologists classification of 3 or higher, case duration of longer than 6 hours, and presence of a resident physician or certified nurse anesthetist were associated with increased likelihood of pulmonary artery catheter (PAC) placement. Age<18 years, or presence of a board-certified anesthesiologist, were associated with a decreased likelihood of catheter placement. The use of PACs has increased from 2010 to 2014. The presence of a PAC did not alter the risk of cardiac arrest intraoperatively. A nonsignificant decrease in mortality was associated with catheter placement. Transfusion was 75% less likely in the PAC cohort than in the control group. Pulmonary artery catheter use remains a mainstay of cardiac anesthesia practice. No significant change in the incidence of intraoperative death was noted, but patients with a PAC were less likely to have blood transfused.