Artery Catheter Use Research Articles

Effect of Perioperative Pulmonary Artery Catheter Use in Cardiac Surgery: A Nationwide Retrospective Cohort Study

Effect of Perioperative Pulmonary Artery Catheter Use in Cardiac Surgery: A Nationwide Retrospective Cohort Study

Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes After Cardiac Surgery: A Nationwide Cohort Study

BackgroundEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce. Research QuestionDoes perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery? Study Design and MethodsThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume. ResultsA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76–0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48–0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65–0.76). InterpretationPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.

Exploring Anesthesiology Management of Living Donor Liver Transplantation: Survey From the Society for the Advancement of Transplant Anesthesia and the Korean Society for Transplantation Anesthesiologists.

While living donor liver transplantation (LDLT) serves as the predominant method of adult liver transplant (LT) in the Republic of Korea (ROK), it represents a minority of LT in the United States (US). A survey was conducted to gain insight into these nations' anesthetic management. An electronic questionnaire was distributed to directors of LT anesthesiology overseeing LDLT programs in both countries between May 2021 and October 2021. The response rate was 93.0% (100% [37/37] in the US and 80% [16/20] in the ROK). Both countries mainly adhered to deceased donor LT recipient management practices, including the frequency of routine pulmonary artery catheter use, transesophageal echocardiography, and point-of-care coagulation monitoring. Differences were observed in early extubation of recipients (US vs. ROK: 39.7%vs. 14.7% of all cases), participation in donor selection meetings (88.9% [32/36] vs. 6.3% [1/16], p < 0.0001), application of the Enhanced Recovery After Surgery donor protocol (69.4% [25/36] vs. 12.5% [2/16], p < 0.0001), and cell saver usage for donors (94.4% [34/36] vs. 18.8% [3/16], p < 0.0001). More ROK programs implemented simultaneous donor/recipient anesthesia supervision by a single anesthesiologist. Several important differences were identified between the US and the ROK in adult LDLT anesthetic management.

Clinical characteristics and short-term outcomes in patients with cardiogenic shock undergoing mechanical circulatory support escalation from intra-aortic balloon pump to impella: From the J-PVAD registry.

An escalation strategy from intra-aortic balloon pump (IABP) to Impella (AbioMed, Danvers, MA, USA) is proposed in patients with cardiogenic shock (CS) refractory to IABP therapy, but its clinical data are lacking. This study aimed to elucidate the clinical characteristics and short-term outcomes in patients undergoing IABP-Impella escalation. From the Japanese nationwide registry of Impella (J-PVAD), a total of 2578 patients with CS receiving Impella support were classified into the IABP-Impella group (n = 189) or the Primary Impella group (n = 2389). We applied 1:3 propensity score (PS) matching, selecting 185 patients and 555 patients, respectively. Before matching, the IABP-Impella group presented longer shock-to-Impella time, worse laboratory data, and more frequent inotropes and pulmonary artery catheter use than the Primary Impella group. After matching, the baseline characteristics were well-balanced. Regarding the 30-day clinical outcomes in the PS-matched cohort, there were no significant differences in the rates of mortality and major complications (a composite of bleeding, hemolysis, infection, stroke, myocardial infarction, limb ischemia, and vascular injury) between the groups. However, The IABP-Impella group showed a significantly higher rate of infection (10.3 % vs. 5.6 %, p = 0.042) and additional mechanical circulatory support use (34.1 % vs. 23.8 %, p = 0.008) than the Primary Impella group. Compared to patients with primary Impella support, those undergoing IABP-Impella escalation showed similar 30-day mortality and major complications despite poorer clinical conditions before Impella support and a more complicated clinical course after Impella insertion.

Pulmonary artery catheter use and in-hospital outcomes in cardiac surgery: a systematic review and meta-analysis.

To determine the association of intraoperative pulmonary artery catheter (PAC) use with in-hospital outcomes in cardiac surgical patients. MEDLINE, Embase, and Cochrane Library (Wiley) databases were screened for studies that compared cardiac surgical patients receiving intraoperative PAC with controls and reporting in-hospital mortality. Secondary outcomes included intensive care unit length of stay, cost of hospitalization, fluid volume administered, intubation time, inotropes use, acute kidney injury (AKI), stroke, myocardial infarction (MI), and infections. Seven studies (25853 patients, 88.6% undergoing coronary artery bypass graft surgery) were included. In-hospital mortality was significantly increased with PAC use [odds ratio (OR) 1.57; 95% confidence interval (CI) 1.12-2.20, P = 0.04]; PAC use was also associated with greater intraoperative inotrope use (OR 2.61; 95% CI 1.54-4.41) and costs [standardized mean difference (SMD) = 0.20; 95% CI 0.16-0.23], longer intensive care unit stay (SMD = 0.29; 95% CI 0.25-0.33), and longer intubation time (SMD = 0.44; 95% CI 0.12-0.76). PAC use is associated with significantly increased odds of in-hospital mortality, but the amount and quality of the available evidence is limited. Prospective randomized trials testing the effect of PAC on the outcomes of cardiac surgical patients are urgently needed.

Pulmonary artery catheter and veno-arterial ECMO training for cardiology fellows: evaluation of a simulation-based program

Abstract Funding Acknowledgements None. Introduction Proficiency in pulmonary artery catheter (PAC) use and extracorporeal membrane oxygenation (ECMO) therapy is crucial for delivering high-quality critical care and improving patient outcomes in cardiac intensive care units (CICUs). Both procedures are conducive to immersive simulation training. Our study focuses on evaluating the efficacy of a simulation-based training program in these specific domains for cardiology fellows. Methods Cardiology fellows participated in two blended learning courses: one on PAC and one on veno-arterial ECMO. The PAC course consisted of a pre-course test of 12 multiple-choice questions assessing knowledge of indications, contraindications, and interpretation of PAC, a 45-minute didactic lecture, followed by a case-based, hands-on simulation training session for 60 minutes. The ECMO course consisted of a pre-course test of 15 multiple-choice questions assessing indications, contraindications, ECMO physiology, and circuit management, a 30-minute didactic lecture, followed by a case-based, hands-on simulation training session. Fellows completed a multiple-choice post-course test within 72 hours post-simulation training. All test questions were designed by experts in cardiac critical care. Results A total of 18 cardiology fellows completed the PAC simulation and 16 completed the ECMO simulation. For the PAC group the average score on the pre-exam was 60%, while on the post exam, the average score increased significantly to 86%, representing a 26% increase (p=0.04). For the ECMO training, the average score on the pre-exam was 67%, and on the post exam, the average score increased substantially to 90% in the ECMO exam, there was a 23% increase in the average post-exam score compared to the pre exam was recorded (p=0.05). Conclusion Simulation-based training in PAC and ECMO has a highly positive impact on the knowledge acquisition of cardiology fellows, with statistically significant increases in average post-exam scores in both areas. These findings not only validate the value of immersive simulation-based training programs but also underscore the need for further investigation into the implementation of educational initiatives aimed at enhancing care in cardiogenic shock.

(491) - Factors Associated with Pulmonary Artery Catheter Use in Cardiogenic Shock Treated with Mechanical Circulatory Support

(491) - Factors Associated with Pulmonary Artery Catheter Use in Cardiogenic Shock Treated with Mechanical Circulatory Support

An analysis of differences in Carbapenem-resistant Enterobacterales in different regions: a multicenter cross-sectional study

ObjectiveThis study aimed to explore the characteristics of carbapenem-resistant Enterobacterales (CRE) patients in the intensive care unit (ICU) in different regions of Henan Province to provide evidence for the targeted prevention and treatment of CRE.MethodsThis was a cross-sectional study. CRE screening was conducted in the ICUs of 78 hospitals in Henan Province, China, on March 10, 2021. The patients were divided into provincial capital hospitals and nonprovincial capital hospitals for comparative analysis.ResultsThis study involved 1009 patients in total, of whom 241 were CRE-positive patients, 92 were in the provincial capital hospital and 149 were in the nonprovincial capital hospital. Provincial capital hospitals had a higher rate of CRE positivity, and there was a significant difference in the rate of CRE positivity between the two groups. The body temperature; immunosuppressed state; transfer from the ICU to other hospitals; and use of enemas, arterial catheters, carbapenems, or tigecycline at the provincial capital hospital were greater than those at the nonprovincial capital hospital (P < 0.05). However, there was no significant difference in the distribution of carbapenemase strains or enzymes between the two groups.ConclusionsThe detection rate of CRE was significantly greater in provincial capital hospitals than in nonprovincial capital hospitals. The source of the patients, invasive procedures, and use of advanced antibiotics may account for the differences. Carbapenem-resistant Klebsiella pneumoniae (CR-KPN) was the most prevalent strain. Klebsiella pneumoniae carbapenemase (KPC) was the predominant carbapenemase enzyme. The distributions of carbapenemase strains and enzymes were similar in different regions.

Uso del catéter de arteria pulmonar en las primeras horas posoperatorias de cirugía cardiovascular de alto riesgo

IntroductionInformation on physiological phenomena in the postoperative period of cardiac surgery, pulmonary artery catheter (PAC) use, and medical behaviors derived from its measurement, is limited. ObjectiveTo describe the patterns of PAC use and therapeutic behaviors derived from it in the first postoperative hours of high-risk cardiovascular surgery. Materials and methodsRetrospective cohort study of high-risk cardiovascular surgery patients, managed with PAC in the intensive care unit of the Hospital Universitario San Ignacio in Bogotá D.C. (Colombia). The therapeutic interventions derived from the hemodynamic evaluation with this catheter were evaluated, taking into account the patterns of use and therapeutic behaviors according to the postoperative moment. ResultsForty-two patients were included. Median age 65 years, 59.5% men, 57.1% with EuroSCORE≥6. Median time of PAC use was 63 h (RIC 45–80). The number of PAC measurements per 12 h decreased from 2.16±0.53 in the first 12 h to 1.30±0.82 after 48 h (p: 0.0003). The number of behaviors taken from each measurement decreased from 1.48±0.45 to 0.71±0.51 (p: 0.0001) in the same period. There was significant reduction in number of behaviors associated with fluid, vasoactive, and vasodilator administration over time. ConclusionsOur data suggest that with the passage of hours the number of PAC measurements is decreasing, as well as the number of behaviors taken based on these measurements. These data suggest that many of the patients who maintained the pulmonary artery catheter for up to 48–72 h no longer required it. Further studies will be needed to clarify which patients benefit from pulmonary artery catheterization beyond 48 h.

Abstract 18823: Outcomes With Pulmonary Artery Catheter Use in Cardiogenic Shock Patients

Introduction: Patients presenting with cardiogenic shock (CS) have a high mortality. Pulmonary artery catheter (PAC) is a well-known invasive tool for guiding escalation and de-escalation of treatments for CS patients. Despite this, paucity of data still exists in outcomes of PAC use in this critically ill population. In this systematic review of the current literature, we report outcomes in in-hospital mortality, length of stay (LOS), and mechanical circulatory support (MCS) use among patients with and without PAC implementation. Methods: A comprehensive search of the MEDLINE, Cochrane, and EMBASE databases was performed from inception to June 2023. Keywords used were “pulmonary artery catheter”, “PA catheter”, and “cardiogenic shock.” Studies without a control group (no PAC arm) were excluded. The endpoints were in-hospital mortality, LOS, and MCS use. Statistical analyses was performed using chi-squared test and t-test. Results: A total of 9 studies were identified for in-hospital mortality, 3 studies for LOS, and 7 for MCS. Among the 166,199 patients with PAC 49,983 died (30%) versus 391,399 among the 1,055,665 patients with no PAC (37%) (P=&lt;0.001). The average LOS among the 2,808 patients with PAC was 3 days versus 10.4 days among the 19,224 patients with no PAC (P=0.09). MCS was used in 51,975 patients of the total 175,838 with PAC (29.6%) versus 323,738 patients of the total 1,179,528 with no PAC (27.4%) (P=0.09). Discussion: In this large systemic review we found statistically significant decrease in in-hospital mortality with PAC use. There was a numerical trend towards average LOS being lower among patients with PAC use although not statistically significant. MCS was utilized more in patients with PAC although not statistically significant. Further studies are needed to identify discrepancies in PAC guided treatment of CS patients.

Characteristics of pulmonary artery catheter use in multicenter ICUs in Japan and the association with mortality: a multicenter cohort study using the Japanese Intensive care PAtient Database

BackgroundIt has been 50 years since the pulmonary artery catheter was introduced, but the actual use of pulmonary artery catheters in recent years is unknown. Some randomized controlled trials have reported no causality with mortality, but some observational studies have been published showing an association with mortality for patients with cardiogenic shock, and the association with a pulmonary artery catheter and mortality is unknown. The aim of this study was to investigate the utilization of pulmonary artery catheters (PACs) in the intensive care unit (ICU) and to examine their association with mortality, taking into account differences between hospitals.MethodsThis is a retrospective analysis using the Japanese Intensive care PAtient Database, a multicenter, prospective, observational registry in Japanese ICUs. We included patients aged 16 years or older who were admitted to the ICU for reasons other than procedures. We excluded patients who were discharged within 24 h or had missing values. We compared the prognosis of patients with and without PAC. The primary outcome was hospital mortality. We performed propensity score analysis to adjust for baseline characteristics and hospital characteristics.ResultsAmong 184,705 patients in this registry from April 2015 to December 2020, 59,922 patients were included in the analysis. Most patients (94.0%) with a PAC in place had cardiovascular disease. There was a wide variation in the frequency of PAC use between hospitals, from 0 to 60.3% (median 14.4%, interquartile range 2.2–28.6%). Hospital mortality was not significantly different between the PAC use group and the non-PAC use group in patients after adjustment for propensity score analysis (3.9% vs 4.3%; difference, − 0.4%; 95% CI − 1.1 to 0.3; p = 0.32). Among patients with cardiac disease, those with post-open-heart surgery and those in shock, hospital mortality was also not significantly different between the two groups (3.4% vs 3.7%, p = 0.45, 1.7% vs 1.7%, p = 0.93, 4.8% vs 4.9%, p = 0.87).ConclusionsThe frequency of PAC use varied among hospitals. PAC use for ICU patients was not associated with lower hospital mortality after adjusting for differences between hospitals.

Outcomes of Patients Transferred to Tertiary Care Centers for Treatment of Cardiogenic Shock: A Cardiogenic Shock Working Group Analysis

BackgroundConsensus recommendations for cardiogenic shock (CS) advise transfer of patients in need of advanced options beyond the capability of ‘spoke’ centers to tertiary/ ‘hub’ centers with higher capabilities. However, outcomes associated with such transfers are largely unknown, beyond those reported in individual health networks. ObjectivesTo analyze a contemporary, multicenter CS cohort with an aim to compare characteristics and outcomes of patients between transfer (between spoke and hub center) and non-transfer cohorts (those primarily admitted to a hub center), for both acute myocardial infarction (AMI-CS) and heart failure related (HF-CS) shock. We also aim to identify clinical characteristics of the transfer cohort that are associated with in-hospital mortality. MethodsThe Cardiogenic Shock Working Group (CSWG) registry is a national, multicenter, prospective registry including high volume (mostly hub) CS centers. Fifteen U.S. sites contributed data for this analysis from 2016–2020. ResultsOf 1890 consecutive CS patients enrolled into the CSWG registry, 1028 (54.4%) patients were transferred. Of these, 528 (58.1%) had heart failure related CS (HF-CS) and 381 (41.9%) had CS related to acute myocardial infarction (AMI-CS). Upon arrival to the CSWG site, transfer patients were more likely to be in SCAI stage C and D, when compared to non-transfer patients. Transfer patients had higher mortality (37% vs. 29%, <0.001) than non-transfer patients with the differences primarily driven by the HF-CS cohort. Logistic regression identified increasing age, mechanical ventilation, renal replacement therapy, and higher number of vasoactive drugs prior to, or within 24 hours after CSWG site transfer as independent predictors of mortality among HF-CS patients. Conversely, pulmonary artery catheter use prior to transfer, or within 24 hours of arrival was associated with decreased mortality. Among transfer AMI-CS patients BMI>28 kg/m2, worsening renal failure, lactate>3 mg/dl and increasing number of vasoactive drugs were associated with increased mortality. ConclusionMore than half of CS patients managed at high volume CS centers were transferred from another hospital. Although transfer patients had higher mortality than those who were primarily admitted to hub centers, outcomes and their predictors varied significantly when classified by HF-CS versus AMI-CS.

Association of pulmonary artery catheter with in-hospital outcomes after cardiac surgery in the United States: National Inpatient Sample 1999–2019

To examine associations of pulmonary artery catheter (PAC) use with in-hospital death and hospital length of stay (days) overall and within subgroups of hospitalized cardiac surgery patients. Secondary analyses of 1999–2019 National Inpatient Sample data were performed using 969,034 records (68% male, mean age: 65 years) representing adult cardiac surgery patients in the United States. A subgroup of 323,929 records corresponded to patients with congestive heart failure, pulmonary hypertension, mitral/tricuspid valve disease and/or combined surgeries. We evaluated PAC in relation to clinical outcomes using regression and targeted maximum likelihood estimation (TMLE). Hospitalized cardiac surgery patients experienced more in-hospital deaths and longer stays if they had ≥ 1 subgroup characteristics. For risk-adjusted models, in-hospital deaths were similar among recipients and non-recipients of PAC (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.96, 1.12), although PAC was associated with more in-hospital deaths among the subgroup with congestive heart failure (OR 1.14, 95% CI 1.03, 1.26). PAC recipients experienced shorter stays than non-recipients (β = − 0.40, 95% CI − 0.64, − 0.15), with variations by subgroup. We obtained comparable results using TMLE. In this retrospective cohort study, PAC was associated with shorter stays and similar in-hospital death rates among cardiac surgery patients. Worse clinical outcomes associated with PAC were observed only among patients with congestive heart failure. Prospective cohort studies and randomized controlled trials are needed to confirm and extend these preliminary findings.

Pulmonary Artery Catheter Use and Outcomes in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock Treated With Impella (a Nationwide Analysis from the United States)

The role of continuous hemodynamic assessment with pulmonary artery (PA) catheter placement in cardiogenic shock (CS) remains debated. We aimed to assess the association between PA catheter placement and clinical outcomes in patients with CS secondary to ST-elevation myocardial infarction (STEMI) treated with an intravascular microaxial flow pump. We identified patients hospitalized with STEMI complicated by CS on mechanical circulatory support with an intravascular microaxial flow pump (Impella, Abiomed, Danvers, Massachusetts) using the National Inpatient Sample database and compared the outcomes in those treated with and without PA catheters. The primary outcome was in-hospital mortality. The secondary outcomes included in-hospital complications, hospital length of stay, inpatient costs, and temporal trends. The total cohort included 14,635 hospitalizations for STEMI complicated by CS treated with Impella between 2016 and 2020, of whom 5,505 (37.6%) received PA catheters. Over the study period, the use of PA catheters increased significantly from 25.9% to 41.8% (ptrend <0.01). Similarly, the use of Impella increased from 9.9% to 18.9% (ptrend <0.01). After adjustment for baseline characteristics using a multivariate logistic regression analysis, PA catheter use was associated with lower in-hospital mortality (adjusted odds ratio 0.80, 95% confidence interval 0.67 to 0.96, p=0.01) and similar cardiovascular, neurologic, renal, and hematologic complications; length of stay; and inpatient costs compared with no PA catheter use. In conclusion, PA catheter use in patients with STEMI complicated by CS treated with Impella is associated with reduced in-hospital mortality and similar complication rates. Given the mortality benefit, further research is necessary to optimize PA catheter use in patients with STEMI with CS.

No association between pulmonary artery catheter use and postoperative complications in off-pump coronary artery bypass grafting: a single-center pilot study.

A pulmonary artery catheter is often used in cardiac surgery despite its uncertain effectiveness. The aim of this pilot study was to investigate the associations between the use of a pulmonary artery catheter and clinical outcomes in off-pump coronary artery bypass grafting. Patients over 20 years of age who had undergone off-pump coronary artery bypass grafting between December 2018 and November 2021 were enrolled in this single-center retrospective pilot study. The propensity score of pulmonary artery catheterization was calculated. Multivariate analysis including the propensity score as a covariate was performed to assess clinical outcomes. The primary outcome was the composite outcome of in-hospital death, unplanned intraoperative conversion to cardiopulmonary bypass, resuscitated cardiac arrest, mechanical circulatory support, myocardial infarction, stroke, new initiation of renal replacement therapy, inhaled nitric oxide, re-intubation and tracheostomy. Among the 315 patients who were enrolled, 298 were included in the final analysis. A pulmonary artery catheter was inserted in 131 patients. There were 50 patients with the composite outcome including two in-hospital deaths. Multivariate logistic regression analysis showed that pulmonary artery catheterization was not significantly related to the composite outcome. Clinical outcomes worsened significantly as the number of anastomoses increased (odds ratio: 1.450, 95% confidence interval: 1.040-2.040, P=0.029). Pulmonary artery catheterization did not improve the clinical outcomes in off-pump coronary artery bypass grafting in this pilot study.

Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock

BackgroundPulmonary artery catheters (PACs) are increasingly used to guide management decisions in cardiogenic shock (CS). The goal of this study was to determine if PAC use was associated with a lower risk of in-hospital mortality in CS owing to acute heart failure (HF-CS). Methods and ResultsThis multicenter, retrospective, observational study included patients with CS hospitalized between 2019 and 2021 at 15 US hospitals participating in the Cardiogenic Shock Working Group registry. The primary end point was in-hospital mortality. Inverse probability of treatment-weighted logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CI), accounting for multiple variables at admission. The association between the timing of PAC placement and in-hospital death was also analyzed. A total of 1055 patients with HF-CS were included, of whom 834 (79%) received a PAC during their hospitalization. In-hospital mortality risk for the cohort was 24.7% (n = 261). PAC use was associated with lower adjusted in-hospital mortality risk (22.2% vs 29.8%, OR 0.68, 95% CI 0.50–0.94). Similar associations were found across SCAI stages of shock, both at admission and at maximum SCAI stage during hospitalization. Early PAC use (≤6 hours of admission) was observed in 220 PAC recipients (26%) and associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, OR 0.54, 95% CI 0.37–0.81). ConclusionsThis observational study supports PAC use, because it was associated with decreased in-hospital mortality in HF-CS, especially if performed within 6 hours of hospital admission. Condensed AbstractAn observational study from the Cardiogenic Shock Working Group registry of 1055 patients with HF-CS showed that pulmonary artery catheter (PAC) use was associated with a lower adjusted in-hospital mortality risk (22.2% vs 29.8%, odds ratio 0.68, 95% confidence interval 0.50–0.94) compared with outcomes in patients managed without PAC. Early PAC use (≤6 hours of admission) was associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, odds ratio 0.54, 95% confidence interval 0.37–0.81).

Survey for Insertion and Management of Peripheral Arterial Catheter in the Acute Care Unit

Background: Arterial catheters are commonly used in acute care units for hemodynamic monitoring in conjunction with blood pressure and blood gas analysis. Complications arising from the use of arterial catheters have been reported; however, few studies have focused on standard practice of arterial catheters. Aim: To clarify the management, particularly the insertion frequency and timing, of peripheral radial arterial catheters in acute care units in Japan. Methods: We developed 34 questions through an interactive process based on guidelines and clinical experience to create a digital survey. This survey was conducted over a month. Participants were nurses working in acute care units in Japan who received electronically distributed surveys through nursing-specific mailing lists and social network services. Results: A total of 451 responses were collected; 224 were used for analysis. Respondents reported 35% implemented routine insertion of arterial catheters for all newly admitted patients, while 58% would insert the arterial catheter within 24 hours of admission. Only 7% of respondents did not add heparin to the pressurized bag. Of the respondents, 51% had a rule to change the pressurized bag of fluids every 3 days. Splinting of the wrist was a routine procedure for 41% of respondents. Conclusions: Arterial catheters were commonly used in all acute care units. Based on the results of the survey, we recommend the use of heparin as a flush fluid should be reconsidered. The high rate of unnecessary arterial catheter insertions and the routine use of splinting need to be reassessed.

Impact of Radial Arterial Location on Catheter Lifetime in ICU Surgical Intensive Care.

Prospective randomized, controlled, single-center study. The surgical ICU of the university hospital of Poitiers in France. From January 2016 to April 2017, all patients over 18 years old admitted to the surgical ICU and requiring an arterial catheter were included. Randomization into two groups: catheter placed near the wrist (within 4 cm of the radiocarpal joint) and catheter placed away the wrist. The primary endpoint was the prevalence of dysfunction. We also compared the prevalence of infection and colonization. One hundred seven catheters were analyzed (14 failed placements with no difference between the two groups, and 16 catheters excluded for missing data), with 58 catheters in near the wrist group and 49 in away the wrist group. We did not find any significant difference in the number of catheter dysfunctions between the two groups (p = 0.56). The prevalence density of catheter dysfunction was 30.5 of 1,000 catheter days for near the wrist group versus 26.7 of 1,000 catheter days for away the wrist group. However, we observed a significant difference in terms of catheter-related infection in favor of away the wrist group (p = 0.04). In addition, distal positioning of the catheter was judged easier by the physicians. The distal or proximal position of the arterial catheter in the radial position has no influence on the occurrence of dysfunction. However, there may be an association with the prevalence of infections.

Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic.

Interrupted time series analysis, adjusted for seasonality and autocorrelation where present, evaluating trends in common ICU practices prior to the pandemic (March 2016 to February 2020), at the onset of the pandemic (April 2020) and intra-pandemic (April 2020 to December 2020). Premier Healthcare Database, containing data from 25% of U.S. discharges from January 1, 2016, to December 31, 2020. Patients without COVID-19 receiving mechanical ventilation for acute respiratory failure. We assessed monthly rates of chest radiograph (CXR), chest CT scans, lower extremity noninvasive vascular testing (LENI), bronchoscopy, arterial catheters, and central venous catheters. We identified 742,096 mechanically ventilated patients without COVID-19 at 545 hospitals. At the onset of the pandemic, CXR (-0.5% [-0.9% to -0.2%; p = 0.001]), LENI (LENI: -2.1% [-3.3% to -0.9%; p = 0.001]), and bronchoscopy rates (-1.0% [-1.5% to -0.6%; p < 0.001]) decreased; use of chest CT increased (1.5% [0.5-2.5%; p = 0.006]). Use of arterial lines and central venous catheters did not change significantly. Intra-pandemic, LENI (0.5% [0.3-0.7%; p < 0.001]/mo) and bronchoscopy (0.1% [0.05-0.2%; p < 0.001]/mo) trends increased relative to pre-pandemic trends, while the remainder of practices did not change significantly. We observed several statistically significant changes to practice patterns among patients without COVID-19 early during the pandemic. However, most of the changes were small or temporary, suggesting that routine practices in the care of mechanically ventilated patients in the ICU was not drastically affected by the pandemic.

Abstract 15567: Pulmonary Artery Catheter Use is Associated With Lower Mortality in Cardiogenic Shock, Especially in Heart Failure Related Shock

Introduction: Recent analyses have shown an increase in the use of pulmonary artery catheter (PAC), with an associated survival benefit in patients with cardiogenic shock (CS). The impact of PAC use on clinical outcomes among patient with CS due to heart failure (HF-CS) versus acute myocardial infarction (AMI-CS) remains unclear. Methods: The Cardiogenic Shock Working Group (CSWG) registry contains real-world data from patients hospitalized with CS across 17 clinical sites between 2016-2020. For this analysis, outcomes in CS patients were analyzed based the presence or absence of PAC, severity of CS (Society for Cardiovascular Angiography and Interventions or SCAI staging) and underlying shock etiology (AMI-CS or HF-CS). Results: Of the 1,890 CS patients included in this analysis, 1473 (77.9%) received a PAC during hospitalization, 593 (31.4%) had AMI-CS (PAC: 485 [81.8%], No PAC: 108 [18.2%]) and 1055 (55.8%) had HF-CS (PAC: 834 [79.1%], No PAC: 221 [20.9%]). Use of PAC was associated with greater drug/device utilization, mechanical ventilation and hospital length of stay, regardless of CS etiology (all p&lt;0.001). Patients with a PAC had significantly less in-hospital mortality in the overall (31% vs 41%, p&lt;0.001) and HF-CS cohort (21% vs 38%, p&lt;0.001), with more significant differences seen in SCAI stages C (p&lt;0.001) and D shock (p=0.01). Presence of PAC was not associated with in-hospital mortality among AMI-CS patients (43% vs 41%, p=0.63), regardless of SCAI stage (all p&gt;0.1). PAC patients were more likely to undergo heart replacement therapy (HRT) when compared to those with no PAC (p&lt;0.05) (Table). Conclusions: Using a large contemporary real-world dataset of CS, we identified that PAC use is associated with less in-hospital mortality and greater HRT compared to patients not receiving a PAC, particularly among HF-CS patients. Further, prospective efforts to define which CS populations derive the greatest benefit from PAC-guided interventions are needed.