Does the Use of a Pulmonary Artery Catheter Make a Difference During or After Cardiac Surgery?

Abstract

Pulmonary artery catheters (PACs) were introduced in 1970. Since then, their use has steadily increased. However, there have been questions raised regarding their efficacy for multiple clinical scenarios. The purpose of this systematic review was to determine the safety and effectiveness of routine use of PACs post cardiac surgery on mortality, complications, days in intensive care unit, days in hospital, and costs in patients undergoing cardiac surgery, or patients who end up in an intensive care unit.

Methods: Medline, All EBM, EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using predetermined search terms. Google, British Medical Journal (BMJ) Best Practice, and the National Institute for Clinical Excellence (NICE) were also searched. All searches were from 2012 to current to update a previous review from 2013. Studies were included if they involved adult cardiac surgery patients, or intensive care unit (ICU) patients requiring haemodynamic monitoring. All other surgical patients were excluded.

Results: Six articles were included in this review. Of the six articles, five were randomised or observational studies, and one was an expert recommendation. For all cardiac surgery patients and patients having coronary artery bypass grafting, there was no difference in mortality. There was an increase in mortality in high-risk cardiac surgery patients, who had a PAC. For patients following coronary artery bypass grafting, there was no difference in ICU length of stay (LOS) but for patients following cardiac surgery total length of hospital stay >30days was greater in patients with a PAC. For patients following coronary artery bypass grafting, in-hospital costs for the entire hospitalisation were higher in patients with a PAC and, there was no difference in complications between PAC and a central venous catheter use. Overall, PACs were not a predictor of worse outcomes.

Conclusion: This review revealed that PAC use was associated with a poorer outcome in a small subset of cardiac surgical patients but in the majority of patients PAC use made no difference to outcome. Further studies are required to confirm the true safety and efficacy of PAC use in cardiac surgery.

Keywords: Adult; Bypass; Graft; Intensive care; Swan Ganz catheter.