Pulmonary Artery Catheterization In Patients Research Articles

Impact of pulmonary artery catheterization in patients with acute myocardial infarction cardiogenic shock.

Acute myocardial infarction (AMI) remains one of the most common causes for cardiogenic shock (CS), with high inpatient mortality (40-50%). Studies have reported the use of pulmonary artery catheters (PACs) in decompensated heart failure, but contemporary data on their use to guide management of AMI-CS and in different SCAI stages of CS are lacking. We investigated the association of PACs and clinical outcomes in AMI-CS. In this retrospective study from a large healthcare system (MedStar Health, 10 hospitals) from 2014 to 2021, patients were grouped according to presentation as ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) and on the basis of SCAI classification. In-hospital mortality was assessed among patients with and without PACs using propensity-matched analysis. A total of 2585 patients were included, of whom 797 had STEMI and 1788 had NSTEMI. Overall, 517 patients underwent PAC placement; PAC utilization rates were 19.7% in the STEMI group and 20.4% in the NSTEMI group. Overall, among patients with AMI-CS, we observed that in-hospital mortality was higher in patients who did not receive PACs during hospitalization (35.9% vs 25.9%, p<0.001). After propensity-matching 484 patients in the PAC group to 484 in the no-PAC group, the no-PAC group still showed higher mortality (34.9% vs 26.7%, p=0.005). Utilization of MCS devices was higher in patients with PAC. In conclusion, our results suggest an advantage in utilizing PACs in AMI-CS patients to identify early CS stages and offer appropriate therapies. Therefore, PACs should be routinely used in for this population.

EFFECT OF PULMONARY ARTERY CATHETERIZATION IN PATIENTS WITH NONISCHEMIC CARDIOGENIC SHOCK: A NATIONWIDE ANALYSIS.

Background: Pulmonary artery catheterization (PAC) has been widely used in critically ill patients, yielding mixed results. Prior studies on cardiogenic shock (CS) predominantly included patients with acute myocardial infarction. This study aims to examine the effect of PAC use in patients with nonischemic CS. Methods: This retrospective cohort study employed data from the National Inpatient Sample database, including weighted hospitalizations of adult patients with nonischemic CS during 2017 to 2019. In-hospital outcomes were compared between groups using inverse probability of treatment weighting. Results: A total of 303,970 patients with nonischemic CS were included, of whom 17.5% received a PAC during their hospitalization. The median age was 67 years (interquartile range: 57-77) and 61% were male. After inverse probability of treatment weighting, patients in the PAC group had significantly lower in-hospital mortality (24.8% vs. 35.3%, P < 0.001), renal replacement therapy (10.7% vs. 12.4%, P = 0.002), in-hospital cardiac arrest (7.1% vs. 9.6%, P < 0.001), and mechanical ventilation (44.6% vs. 50.4%, P < 0.001) compared to non-PAC group. In contrast, the PAC group had higher use of intra-aortic balloon pump (15.4% vs. 3.4%, P < 0.001), percutaneous ventricular assist devices (12.6% vs. 2.6%, P < 0.001), extracorporeal membrane oxygenation (3.9% vs. 2.5%, P < 0.001), and heart transplantation (2.1% vs. 0.4%, P < 0.001). Conclusion: In the real-world setting, invasive hemodynamic monitoring with PAC in patients with nonischemic CS is associated with survival benefits and a reduction in adverse events, including reduced need for renal replacement therapy, mechanical ventilation and risk of in-hospital cardiac arrest.

INVASIVE HEMODYNAMIC MONITORING WITH PULMONARY ARTERY CATHETER IN SEPSIS-ASSOCIATED CARDIOGENIC SHOCK.

Background: Both sepsis-induced cardiomyopathy and worsening of preexisting cardiac disease can contribute to circulatory shock in septic patients. The early use of pulmonary artery catheter (PAC) could play a pivotal role in the management of sepsis-associated cardiogenic shock. In this study, we aimed to evaluate the impact of early invasive hemodynamic monitoring with PAC in patients with sepsis-associated cardiogenic shock. Method: We performed a retrospective study using the National Inpatient Sample data from January 2017 to December 2019. The early use of PAC was defined as the use of PAC within 2 days from the admission. We performed the multivariable logistic regression analysis to investigate the association between the early use of PAC and in-hospital mortality in patients with sepsis-associated cardiogenic shock and sepsis without cardiogenic shock, respectively. Results: There was no difference in in-hospital mortality between PAC and no PAC groups in sepsis without cardiogenic shock (adjusted odds ratio [aOR] = 1.05, 95% confidence interval [CI] = 0.82-1.35, P = 691). On the other hand, the early use of PAC was independently associated with lower in-hospital mortality in patients with sepsis-associated cardiogenic shock (aOR = 0.58, 95% confidence interval [CI] = 0.46-0.72, P < 0.001). The use of PAC was also associated with increased use of mechanical circulatory support in those with sepsis-associated cardiogenic shock (aOR = 12.26, 95% CI = 9.37-16.03, P < 0.001). For patients with sepsis-associated cardiogenic shock, the use of PAC after 2 days of admission was associated with significantly higher in-hospital mortality and decreased use of mechanical circulatory support. Conclusion: The use of pulmonary artery catheters in sepsis-associated cardiogenic shock was associated with significantly lower in-hospital mortality and increased use of mechanical circulatory supports in patients with sepsis-associated cardiogenic shock.

Abstract 127: Trends of Racial Disparities and the In-Hospital Outcomes of Patients With Pulmonary Artery Catheterization for Cardiogenic Shock

Introduction: The use of pulmonary artery catheterization (PAC) in patients with cardiogenic shock (CS) has been associated with improved outcomes in non-randomized studies. However, the racial difference in PAC utilization and outcomes in CS have not been assessed. Methods: We identified all patients with CS who had PAC from the national inpatient sample of the Health Care Utilization Project database between 2016 - 2020. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians Outcomes of interest included in-hospital mortality and use mechanical circulatory support (MCS) by ethnic group. Result: From 76,815 patients who underwent PAC during CS admission 64.18% of were Whites, 24.78% Blacks, 8.19% Hispanics, and 2.85% Asians. Black patients were younger, had higher prevalence of obesity, CHF, nicotine use and oxygen dependence. Compared to whites, blacks had lower mortality (aOR: 0.79; CI: 0.69 - 099, p=0.043), respiratory failure (aOR: 0.67; CI: 0.59 - 0.81, p&lt;0.001), mechanical support device utilization (aOR: 0.73, CI; 0.67 - 0.81, p&lt;0.001), and pacemaker utilization (aOR: 0.37; CI: 0.18 - 0.78, p=0.008). Hispanics had a longer length of stay (21 days vs 17.7 days). Blacks had higher rates of PAC use than other racial minorities between and mortality rates in blacks were noted to decline significantly in patients that had PAC during hospitalizations for CS (aOR: 0.49, CI; 0.46 - 0.52, p&lt;0.001). Conclusion: The utilization of PAC in patients with CS is associated with better outcomes, including mortality and this was noted as well in the individual racial subgroups. Despite these findings, racial disparities persist. These disparities could be alleviated by equitable distribution of healthcare resources.

Clinical impact of pulmonary artery catheter in patients with cardiogenic shock: A systematic review and meta-analysis

BackgroundThe clinical utility of the pulmonary artery catheter (PAC) for the management of cardiogenic shock (CS) remains controversial. We performed a systematic review and meta-analysis exploring the association between PAC use and mortality among patients with CS. MethodsPublished studies of patients with CS treated with or without PAC hemodynamic guidance were retrieved from MEDLINE and PubMed databases from January 1, 2000, to December 31, 2021. The primary outcome was mortality, which was defined as a combination of in-hospital mortality and 30-day mortality. Secondary outcomes assessed 30-day and in-hospital mortality separately. To assess the quality of nonrandomized studies, the Newcastle-Ottawa Scale (NOS), a well-established scoring system was used. We analyzed outcomes for each study using NOS with a threshold value of >6, indicating high quality. We also performed analyses based on the countries of the studies conducted. ResultsSix studies with a total of 930,530 patients with CS were analyzed. Of these, 85,769 patients were in the PAC-treated group, and 844,761 patients did not receive a PAC. PAC use was associated with a significantly lower risk of mortality (PAC: 4.6 % to 41.5 % vs control: 18.8 % to 51.0 %) (OR 0.63, 95 % CI: 0.41–0.97, I2 = 0.96). Subgroup analyses demonstrated no difference in the risk of mortality between NOS ≥ 6 studies and NOS < 6 studies (p-interaction = 0.57), 30-day and in-hospital mortality (p-interaction = 0.83), or the country of origin of studies (p-interaction = 0.08). ConclusionsThe use of PAC in patients with CS may be associated with decreased mortality. These data support the need for a randomized controlled trial testing the utility of PAC use in CS.

Pro: We Should Use a Pulmonary Artery Catheter with Right Ventricular Pressure Waveforms in Cardiac Surgical Patients

Although pulmonary artery catheters (PAC) are used worldwide, their benefit is still a matter of debate. Recent studies have shown a survival benefit after cardiogenic shock in patients receiving a PAC. 1 Ranka S Mastoris I Kapur NK et al. Right heart catheterization in cardiogenic shock is associated with improved outcomes: Insights from the nationwide readmissions database. J Am Heart Assoc. 2021; 10e019843 Crossref Scopus (15) Google Scholar ,2 Chow JY Vadakken ME Whitlock RP et al. Pulmonary artery catheterization in patients with cardiogenic shock: A systematic review and meta-analysis. Can J Anesth. 2021; 68: 1611-1629 Crossref PubMed Scopus (9) Google Scholar However, as mentioned by Thiara et al., 3 Thiara S Griesdale DEG. The pulmonary artery catheter: A solution still looking for a problem. Can J Anesth. 2021; 68: 1592-1596 Crossref PubMed Scopus (1) Google Scholar it is unlikely that a randomized controlled trial will suffice to answer this question, first because of the complexity of patients in which this modality is used, and second because of the role individual competence plays in its successful use. In order to understand how to best select cardiac surgical patients in which to use PACs, the authors have proposed the following 4 questions.

Abstract 13997: What is the Role of Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction Complicated With Cardiogenic Shock?

Background: Acute myocardial infarction (AMI) remains one of the most common cause for cardiogenic shock (CS). Emergent revascularization with and without mechanical support demonstrated the benefit in patients with AMI-CS, but data on the utility of pulmonary artery catheter (PAC) in patients with AMI-CS is lacking. Methods: We performed a retrospective study from a large healthcare system (11 hospitals) from October 1 st 2014 to October 2021. We divided the patients with AMI-CS, into two groups those who received PAC and those who did not. Propensity matched analysis was performed for baseline characteristics, comorbidities, and laboratory values to account for the underlying cofounders. The in-hospital outcome was recorded for both groups Results The total cohort included 2585 patients (STEMI: 797; NSTEMI: 1788). Of these 517 patients underwent PAC placement: 19.7 % of the patients in the STEMI group, and 20.4% of patients in the NSTEMI group. Mean age was similar among the PAC and the non-PAC groups (68.87 years vs 67.12 years respectively. Patients who underwent PAC had more diabetes (59.4% vs 53.1%, p=0.011), chronic kidney disease (50.9% vs45.2%, p=0.020), and coronary artery disease (77.8% vs 71.9%, p = 0.007). Overall, in-hospital mortality was lower in patients who underwent PAC and higher in patients who did not receive PAC (25.9% vs 35.9%, p&lt;0.001) and these results remained significant after propensity matching as shown in Figure 1. Similar results were seen across all SCAI stages with improved mortality in PAC group. Overall mechanical circulatory device utilization was higher in the PAC group. Conclusion Our study shows that the use of PAC patients with AMI-CS was associated with improved mortality. If proven in randomized clinical trials PAC should be routinely used for all patients presenting with AMI-CS.

The utilization and mortality benefits of pulmonary artery catheterization in patients with cardiogenic shock

Abstract Introduction Pulmonary artery catheterization (PAC) can provide essential hemodynamic data to assist in managing critical patients with cardiogenic shock. The use of PAC has been controversial as clinical studies have shown a lack of benefit. However, with the recent widespread availability of mechanical circulatory assists devices, the application and benefits of PAC are expected to rise. Purpose To determine the impact of PAC on inpatient outcomes and the utilization of advanced heart failure devices in these patients. Methods The National Inpatient Sample from 2016 to 2018 was queried to identify patients with cardiogenic shock. Of these patients, we compared those who received invasive hemodynamic monitoring (IHM) with PAC to those who did not receive PAC. Patients under age 18 and those undergoing surgical or transcatheter cardiac procedures during the same admission were excluded. Multivariate logistic regression was used to select matched samples between groups accounting for patient/hospital demographics and medical comorbidities. The primary endpoint was a comparison of in-hospital mortality, length of hospitalization, and medical costs. The secondary endpoints compared the utilization of mechanical circulatory assists devices: percutaneous ventricular assist devices (pVAD), extracorporeal membrane oxygenation (ECMO), and left ventricular assist device (LVAD), and the incidence of post-PAC complications: pneumothorax, sepsis, and hemorrhage/hematoma. Results We identified a total of 279,619 patients admitted with cardiogenic shock, of these patients 25,166 (9%) received IHM with PAC. Patients who had PAC had decreased in-hospital mortality (22.3% vs 29.7%; p&amp;lt;0.001), increased length of hospitalization (12 days vs 9 days; p&amp;lt;0.001), and increased medical costs ($65,884 vs $47,983; p&amp;lt;0.001). Furthermore, in patients with PAC there was increased utilization of pVAD (4.5% vs 1.9%; p&amp;lt;0.001), ECMO (0.07% vs 0.01%; p&amp;lt;0.001), and LVAD (2.2% vs 0.3%; p&amp;lt;0.001). There was no difference in the prevalence of post-PAC complications between both groups. Conclusions The use of IHM with PAC was associated with improved mortality and utilization of mechanical circulatory assist devices in patients with cardiogenic shock without increasing risk for post-procedural complications. Therefore, the increased average duration and medical costs of hospitalization with PAC patients likely resulted from improved patient survival. Therefore, the present study indicated that IHM with PAC is safe and beneficial for patients with cardiogenic shock. Funding Acknowledgement Type of funding sources: None.

Non-invasive assessment of right ventricular function and pulmonary pressures in cardiogenic shock remains challenging: don't pack away the PAC just yet

Abstract Background Cardiogenic shock (CS) is associated with high levels of morbidity and mortality despite advances in treatment. Patients with right ventricle (RV) dysfunction have been shown to have poorer outcomes. It is suggested that invasive monitoring through pulmonary artery catheter (PAC) placement can assist in guiding management to improve survival, though they are associated with adverse events. Purpose This study assessed the utility of non-invasive, echocardiographic assessment of RV performance and pulmonary artery pressures (PAP) in patients with CS. Methods Consecutive patients admitted to a North American quaternary cardiac intensive care unit who had PAC placement were recruited into this study. Invasive haemodynamic assessment was followed by transthoracic echocardiography (TTE) performed by a critical care cardiologist, blinded to the invasive measurements. TTE images were later reported by a second cardiologist, blinded to the invasive measurements and the patient. Correlations between RV and pulmonary invasive and non-invasive parameters were evaluated using Pearson's correlation. Results Overall, 96 assessments of 60 patients were compared. Patients were predominantly male (73%), aged 58±14 years and SCAI stage C (55%) and D (22%) at the time of assessment. Invasive measurements of right heart and pulmonary function was possible in all patients. Mean RAP was 8.5±4.7 mmHg, systolic PAP 37.5±9.9 mmHg, diastolic PAP 18.1±6.5 mmHg, mean PAP 25.1±7.2 mmHg, pulmonary capillary wedge pressure (PCWP) 16.0±16.4 mmHg, pulmonary vascular resistance (PVR) 157±99dyn s cm–5, RV stroke work index (RVSWI) 7.0±3.9 g min/m2 and PAP index (PAPi) 2.9±4.2. When compared to non-invasive echocardiographic parameters, there was little correlation with invasive values (Table). RVSWI moderately correlated with peak tricuspid regurgitation (TR) velocity, tricuspid annular plane systolic excursion (TAPSE) and estimated systolic PAP; while peak TR velocity was mild-moderately correlated with PAP and PCWP. No single non-invasive parameter demonstrated strong prediction of invasive values. Conclusion Non-invasive assessment of right heart and pulmonary haemodynamic parameters is of limited validity when compared with invasive monitoring through PAC in patients with CS. PAC remains the most reliable method of assessing the RV haemodynamic profile in CS. Future studies should evaluate the clinical benefit of invasive haemodynamic monitoring in this population. Funding Acknowledgement Type of funding sources: None.

Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery.

ABSTRACTBackground:An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries.Aim:The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB).Settings and Design:We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaS Hemodynamic Navigator system and the gold standard TD method using pulmonary artery catheter in patients undergoing OPCAB. A total of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery.Patients and Methods:We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman. The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve.Results:Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres. The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%.Conclusion:A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.

Diagnostic value of right heart and pulmonary artery catheterization in patients with suspected pulmonary hypertension. Part 2. Invasive study of parameters of hemodynamics and oxygen transport

The aim – evaluate the parameters of pulmonary and systemic hemodynamics obtained in patients with various forms of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in Ukraine.Materials and methods. The study included 195 patients: IPAH was in 68 patients; PAH associated with connective tissue diseases (CTD) – in 21 patients; PAH associated with HIV infection – in 4 patients; PAH associated with portal hypertension (PH) – in 4 patients; PAH associated with congenital heart disease – in 25 patients; CTEPH – in 51 patients, pulmonary hypertension (PH) associated with left heart disease (LHC) – in 5 patients and 17 patients who were excluded from the diagnosis of PH. From 2014 to 2019, these patients underwent 220 procedures of right heart catheterization (RHC) in accordance with current European Guidelines. Also, all patients underwent echocardiographic examination and determined the gas composition of blood and indicators of acid-base balance using the ABL 735 analyzer, calculated the parameters of the affinity of hemoglobin to oxygen (p50).Results and discussion. The lowest level of arterial blood oxygen saturation was in the group of patients with PH due to LHD – 88.9 % (p&lt;0.05); in other groups it averaged 94–97 %. The oxygen content in arterial blood was the lowest in the group of patients with PH due to LHD – 15.7 ml/L (p&lt;0.05); in other groups this indicator was equal to 17.4–18.7 ml/L. The lowest oxygen saturation of mixed venous blood (SvO2) was in the PAH group associated with HIV – 58 % (p&lt;0.05), and close to critical (&lt; 65 %) SvO2 level was observed in the IPAH group – 66.3 %. CTEPH – 66.0 %. The highest level of this indicator was in the PAH group associated with portal hypertension – 81.1 %. The arterio-venous difference was highest in the PAH associated with HIV group – 5.6 ml/L, and the smallest in the PAH associated with PH group – 2 ml/L. On the other hand, the oxyhemoglobin dissociation curve was almost normal in all groups, except for the group of patients with PAH associated with portal hypertension.Conclusions. The most severe disorders of hemodynamics and oxygen transport were observed in the group of PAH patients associated with HIV compared with other forms of PAH and CTEPH. The IPAH and CTEPH groups were similar in terms of hemodynamics, despite a different pathophysiological mechanism. In the group of patients with PAH associated with CTD, the results of the RHC were slightly better than in the group of patients with IPAH, reflecting that the hemodynamic component is not the leading one for prognosis in these patients. Also, the performance of the right ventricle was significantly higher in patients with PAH compared with the group without PH.

Pulmonary artery catheterization in patients with cardiogenic shock: a systematic review and meta-analysis.

Cardiogenic shock carries high morbidity and mortality. The purpose of this review was to determine the safety and efficacy of pulmonary artery catheterization (PAC) in adult patients hospitalized with cardiogenic shock. We performed a systematic review and meta-analysis of observational studies and randomized controlled trials comparing PAC vs no PAC in cardiogenic shock. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and grey literature. We screened articles, abstracted data, and evaluated risk of bias in duplicate. We pooled data using a random-effects model and evaluated the quality of evidence using the GRADE framework. Outcomes of interest were mortality, length of stay, and procedural complications. We identified 19 eligible observational studies (≥ 2,716,287 patients) and no randomized controlled trials; 14 studies were at high risk of bias (lack of adjustment for prognostic variables and/or co-interventions). When pooling adjusted results, PAC was associated with improved survival to hospital discharge (relative risk [RR], 0.77; 95% confidence interval [CI], 0.64 to 0.91, I2 = 98%; very low-quality evidence) and at longest available follow-up (RR, 0.72; 95% CI, 0.60 to 0.87; I2 = 99%; very low-quality evidence). Unadjusted length of stay was 3.5 days longer (95% CI, 1.49 to 5.54; I2 = 100%; very low-quality evidence) with PAC. Procedural complications were inconsistently reported. Very low-quality observational evidence suggests PAC use in patients with cardiogenic shock is associated with lower mortality. Overall, these results support consideration of PAC for hemodynamic assessment in cardiogenic shock. Prospective randomized clinical trials are needed to further characterize the role of PAC in this population.

Pulmonary Artery Catheter in Patients with Severe Acute Pancreatitis: A Single-Center Retrospective Study.

It is still uncertain what effects pulmonary artery catheter (PAC)-guided resuscitation has on outcomes for patients with severe acute pancreatitis (SAP). Therefore, we aimed to investigate the effect of PAC on hospital mortality in patients with SAP. We collected the data of patients with a diagnosis of SAP from January 10, 2017, to July 30, 2019. Patients were divided into a PAC group and a control group. The primary outcome measured was the day-28 mortality. Secondary outcomes included day-90 mortality, duration of ICU and hospital stay, ventilation days, usage of renal support and vasoactive agents, incidences of acute abdominal compartment syndrome, infusion volumes, and fluid balance and hemodynamic characteristics measured by the PAC. Kaplan-Meier analysis was applied to estimate survival outcomes. Complications related to PAC were also analyzed. There was no significant difference between the PAC group and the control group for day-28 mortality (22.7% vs. 30%, odds ratio, 0.69; 95% CI 0.31-1.52; P = 0.35). The duration of ICU stay in the PAC group was shorter (P = 0.00), and the rate of dependence on renal support treatment was lower in the PAC group than in the control group (P = 0.03). There was no difference in other secondary outcomes and no significant difference in the survival curve between the two groups (log-rank P = 0.72, X2 = 0.13). However, SAP patients inserted PAC within 24h ICU admission showed that duration of renal support therapy in PAC patients within 24h ICU admission (mean days, 1.60; standard deviation, 0.14) was shorter than those with 24-72h ICU admission (mean days, 2.94; standard deviation, 0.73; P = 0.03). The organ failure rates (1 organ, 2 organs and 3 organs) were all lower in PAC patients within 24h ICU admission than with 24-72h ICU admission (P = 0.02, P = 0.02, P = 0.048, respectively). In patients with severe acute pancreatitis, PAC-guided fluid resuscitation shortened the duration of ICU stay, and patients in the PAC group had a lower rate of dependence on renal support, while no benefit in terms of mortality was observed. However, SAP patients inserted PAC within 24h ICU admission showed shorter duration of renal support therapy and lower organ failure rates than those with 24-72h ICU admission, indicating that early use of PAC, especially within 24h, might be better for SAP patients.

Accuracy and Trending Ability of the Fourth-Generation FloTrac/EV1000 System in Patients With Severe Aortic Valve Stenosis Before and After Surgical Valve Replacement

Evaluate the accuracy and trending ability of the fourth-generation FloTrac/EV1000 (Edwards Lifesciences, Irvine, CA) system in patients with severe aortic valve stenosis by comparing FloTrac/EV1000-derived cardiac output (CCO-FT) with continuous thermodilution pulmonary artery catheter (CCO-PAC) measurements before and after surgical valve replacement. Prospective clinical study. Anesthesia for cardiac surgery, operating room, single-center university hospital. Twenty-five patients were included. After exclusion, 20 patients undergoing elective aortic valve replacement were analyzed. After induction of general anesthesia, CCO-FT and CCO-PAC values were recorded every 30 seconds before and after aortic valve replacement with a bioprosthesis under cardiopulmonary bypass (CPB). Data were analyzed separately from skin incision to last suture and before and after CPB. Regression analyses, Bland-Altman analyses, and trending analyses (4-quadrant plot, polar plot) were performed. The percentage errors of the FloTrac/EV1000 were 69.7% and 59.3% before and after CPB, respectively. The concordance rates (CRs) and angular CRs of the FloTrac/EV1000 were 50.9% and 57.1%, and 48.7% and 61.9% before and after CPB, respectively. This study revealed a low level of agreement and poor trending ability of the FloTrac/EV1000 system compared to continuous thermodilution pulmonary artery catheter in patients with severe aortic stenosis. Although there was a slight improvement after surgical valve replacement and CPB, the results were not within acceptable limits to replace CCO-PAC in this patient population.

TCT-511 Does Pulmonary Artery Catheterization improve in-hospital outcomes in patients with cardiogenic shock: ANALYSIS FROM NATIONAL INPATIENT SAMPLE (NIS)

Pulmonary artery catheterization(PAC) is an option in cardiogenic shock(CS) patients for rapid diagnosis and to direct mechanical and pharmacological support. We evaluated contemporary outcomes of PAC in patients with CS. Subjects were obtained from the national inpatient sample database. ICD-9-CM

Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock

Objectives: The impact of pulmonary artery catheterization (PAC) on survival in patients with cardiogenic shock (CS) is not well established. This study aimed to assess whether Swan-Ganz catheter monitoring is related to short- and long-term mortality in patients with CS. Methods: One hundred and twenty-nine consecutive patients with a first admission for CS were prospectively enrolled in a single-center registry between December 2005 and May 2009, and were subsequently followed up over 5.3 years. Results: PAC was used in 64% of all patients with a mean age of 68 years (65% men). After adjustment for age, gender and the presence of CS upon admission, PAC was associated with lower short-term mortality [hazard ratio (HR) = 0.55, 95% confidence interval (CI) 0.35-0.86, p = 0.008] as well as lower mortality rates in the long-term follow-up (HR = 0.63, 95% CI 0.41-0.97, p = 0.035). In a subgroup analysis, the use of PAC was associated with reduced mortality in patients without acute coronary syndrome (ACS), i.e. 49% in the Swan-Ganz group vs. 82% (p = 0.010), but there was no difference within the ACS group. Conclusions: The use of PAC in patients with CS was associated with lower short- and long-term mortality rates after adjustment for age, gender and the presence of shock upon admission. This benefit was only significant in those patients without ACS.

Learning effectiveness of nurses caring for patients with pulmonary artery catheters using e-learning and simulation approaches

Background: There has not been a systematic training program developed for pulmonary artery catheter (PAC) care in Taiwan, only the mentor-apprentice learning approach is used. Therefore, it is difficult for nursing personnel to maintain mastery of care. Methods: This study used single group pretest and posttest and repeated measurements to enroll the ICU nurse practitioners of regional teaching hospitals to perform the pretest, post-test, and repeated measurements, in order to follow-up the long-term learning effectiveness. Before and after the intervention of “Multimedia interactive self-learning disc of Pulmonary Artery Catheter” and “Practical Operation of Scenario Simulation,” this study used the scale on knowledge, attitude, technique inspection, and satisfaction of PAC care to collect data. Results: The differences in the scores of the posttest and repeated measurements of knowledge and technique inspection of PAC care reached significance ( p < .05). The differences in the scores of “Beneficial to the improvement of self-confidence in care” and “I believe that I can provide accurate data for decision-making” of care attitude in the posttest, and those of “During the insertion of pulmonary artery catheter in patients, I will look up the information to look for answers” reached significance ( p < .05). The learners were all satisfied. Conclusion: This study considered the needs of learners, and developed the “self-learning disc” according to the theory. The results showed that the interventions have long-term learning effectiveness on the knowledge, attitude, and technique inspection of PAC care. The research can be provided as reference for the PAC care training.

Video Fluoroscopy for Positioning of Pulmonary Artery Catheters in Patients Undergoing Cardiac Surgery.

To determine whether video fluoroscopy combined with traditional pressure waveform analyses facilitates optimal pulmonary artery catheter (PAC) flotation and final positioning compared with the traditional pressure waveform flotation technique alone. Prospective, single-center, randomized, controlled trial. Single-center university teaching hospital. The study included 50 cardiac surgery patients at higher risk for PAC complications. Use of video fluoroscopy to facilitate optimal PAC flotation and positioning. The primary outcome was the time taken to float and position the PAC balloon in the pulmonary artery as confirmed by transesophageal echocardiography. Secondary outcomes included number of attempts at flotation, ventricular rhythm disturbances, and catheter malposition. Patients were evenly matched in baseline demographics, New York Heart Association symptoms of heart failure, severity of left and right ventricular dysfunction, end-diastolic pressures and dimensions, severity of tricuspid valvular disease, and atrial and pulmonary artery pressures. Mean (SD) time to float the PAC was significantly shorter in the video fluoroscopy group than in the usual care group: 73 seconds (SD, 65.1) versus 176 seconds (SD, 180.6), respectively; p = 0.014. The median (interquartile range [IQR]) number of attempts to successful flotation was fewer in the video fluoroscopy group than in the usual care group: 1 (IQR 1:2) attempt versus 2 (IQR 1:4) attempts, respectively; p = 0.007. The composite complication rate (malposition and arrhythmias) was lower in the video fluoroscopy group than in the usual care group (16% v 52%, respectively; p = 0.01). In cardiac surgery patients at higher risk for PAC complications, video fluoroscopy facilitated faster and safer catheter flotation and positioning compared with the traditional pressure waveform flotation technique.

The utility of transoesophageal echocardiography for estimating right ventricular systolic pressure.

With the reduction in use of the pulmonary artery catheter, alternative methods of pulmonary pressure estimation are required. The use of echocardiographically-derived right ventricular systolic pressure has recently been questioned, but this technique has not been validated in anaesthetised surgical patients with transoesophageal echocardiography. One hundred measurements of right ventricular systolic pressure with transoesophageal echocardiography were compared with the pulmonary artery systolic pressure obtained simultaneously from a pulmonary artery catheter in patients undergoing cardiac surgery. Simultaneous right ventricular systolic pressure and pulmonary artery systolic pressure measurements were possible in all patients, and these measurements were strongly correlated (r = 0.98, p<0.001), with minimal bias and narrow limits of agreement (approximately -5 to +5mmHg), across a broad range of pulmonary pressures. Measurement of right ventricular systolic pressure using tranoesophageal echocardiography is readily achievable and closely correlates with pulmonary artery systolic pressure, with minimal bias, in cardiac surgical patients undergoing general anaesthesia and positive pressure mechanical ventilation of the lungs.

Pulmonary Artery Catheter for Coronary Artery Bypass Graft

Pulmonary Artery Catheter for Coronary Artery Bypass Graft