The Pulmonary Artery Catheter in Cardiogenic and Post-Cardiotomy Shock—Analysis of Recent Data

Abstract

Since its development and introduction in the 1970s, the use of the pulmonary artery catheter (PAC) has remained controversial, even with widespread use in cardiac surgery and in the cardiothoracic and vascular critical care populations. Despite worldwide use, data regarding the efficacy and safety in high-risk populations have been sparse and conflicting in chronic versus acute heart failure (HF). In 2005, the landmark ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial in chronic HF enrolled 433 patients for whom the clinical decision to use or not to use a PAC could be categorized as being in a state of clinical equipoise. 1 Binanay C Califf RM Hasselblad V et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: The ESCAPE trial. JAMA. 2005; 294: 1625-1633 Crossref PubMed Scopus (987) Google Scholar The study demonstrated that the use of a PAC increased the risk of adverse events without any benefit to mortality or length of hospitalization. Cardiogenic shock (CS), however, is a different story—the information obtained from PA catheters is central to defining CS. The results of the ESCAPE trial cannot be extrapolated to this population. Aside from the classic “cold and wet” CS, there are types of CS that are difficult to determine without invasive hemodynamic monitoring (Fig 1). Thus, the 2019 expert consensus statement on CS endorsed the use of PAC for the diagnosis and management of CS in the absence of randomized control trials in the CS population. 2 Baran DA Grines CL Bailey S et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019; 94: 29-37 PubMed Google Scholar