Pulmonary artery catheter use in adult patients undergoing cardiac surgery: a retrospective, cohort study

Andrew D Shaw,David K Hayashida,Douglas Shook,Michael G Mythen,Xuan Zhang,Jeffrey R Skaar,Sloka S Iyengar,Sibyl H Munson

doi:10.1186/s13741-018-0103-x

Abstract

BackgroundThe utility of pulmonary artery catheters (PACs) and their measurements depend on a variety of factors including data interpretation and personnel training. This US multi-center, retrospective electronic health record (EHR) database analysis was performed to identify associations between PAC use in adult cardiac surgeries and effects on subsequent clinical outcomes.MethodsThis cohort analysis utilized the Cerner Health Facts database to examine patients undergoing isolated coronary artery bypass graft (CABG), isolated valve surgery, aortic surgery, other complex non-valvular and multi-cardiac procedures, and/or heart transplant from January 1, 2011, to June 30, 2015. A total of 6844 adults in two cohorts, each with 3422 patients who underwent a qualifying cardiac procedure with or without the use of a PAC for monitoring purposes, were included. Patients were matched 1:1 using a propensity score based upon the date and type of surgery, hospital demographics, modified European System for Cardiac Operative Risk Evaluation (EuroSCORE II), and patient characteristics. Primary outcomes of 30-day in-hospital mortality, length of stay, cardiopulmonary morbidity, and infectious morbidity were analyzed after risk adjustment for acute physiology score.ResultsThere was no difference in the 30-day in-hospital mortality rate between treatment groups (OR, 1.17; 95% CI, 0.65–2.10; p = 0.516). PAC use was associated with a decreased length of stay (9.39 days without a PAC vs. 8.56 days with PAC; p < 0.001), a decreased cardiopulmonary morbidity (OR, 0.87; 95% CI, 0.79–0.96; p < 0.001), and an increased infectious morbidity (OR, 1.28; 95% CI, 1.10–1.49; p < 0.001).ConclusionsUse of a PAC during adult cardiac surgery is associated with decreased length of stay, reduced cardiopulmonary morbidity, and increased infectious morbidity but no increase in the 30-day in-hospital mortality. This suggests an overall potential benefit associated with PAC-based monitoring in this population.Trial registrationThe study was registered at clinicaltrials.gov (NCT02964026) on November 15, 2016.

Highlights

The utility of pulmonary artery catheters (PACs) and their measurements depend on a variety of factors including data interpretation and personnel training
Multiple studies have addressed PAC use in cardiac surgery patients, who currently receive 30% of PACs (Bernard et al 2000). These range from increased mortality and a greater risk of severe organ complications associated with PAC use during coronary artery bypass grafting (CABG) (Schwann et al 2011), increased mortality in high-risk cardiac surgery patients (Chiang et al 2015), and no additional risk of cardiac arrest intraoperatively combined with a non-significant decrease in mortality and a lower likelihood of blood transfusion in patients undergoing CABG (Brovman et al 2016)
EuroSCORE European System for Cardiac Operative Risk Evaluation (II) values did not differ between arms, which are inclusive of variables such as procedure urgency, critical preoperative state, left ventricular function, weight of intervention, procedures of the thoracic aorta, among other key characteristics (Supplemental Information S2)

Summary

Introduction

The utility of pulmonary artery catheters (PACs) and their measurements depend on a variety of factors including data interpretation and personnel training. This US multi-center, retrospective electronic health record (EHR) database analysis was performed to identify associations between PAC use in adult cardiac surgeries and effects on subsequent clinical outcomes. Multiple studies have addressed PAC use in cardiac surgery patients, who currently receive 30% of PACs (Bernard et al 2000) These range from increased mortality and a greater risk of severe organ complications associated with PAC use during coronary artery bypass grafting (CABG) (Schwann et al 2011), increased mortality in high-risk cardiac surgery patients (Chiang et al 2015), and no additional risk of cardiac arrest intraoperatively combined with a non-significant decrease in mortality and a lower likelihood of blood transfusion in patients undergoing CABG (Brovman et al 2016). Despite a lack of consensus and mixed messages surrounding PAC utility, PAC use increased significantly from 2010 to 2014 (Brovman et al 2016)

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