Multicenter Study

. 2023 Aug;11(8 Pt 1):903-914.

doi: 10.1016/j.jchf.2023.04.007. Epub 2023 Jun 14.

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit

Bernard S Kadosh¹, David D Berg², Erin A Bohula², Jeong-Gun Park², Vivian M Baird-Zars², Carlos Alviar³, James Alzate⁴, Christopher F Barnett⁵, Gregory W Barsness⁶, James Burke⁷, Sunit-Preet Chaudhry⁸, Lori B Daniels⁹, Andrew DeFilippis¹⁰, Anthony Delicce⁴, Christopher B Fordyce¹¹, Shahab Ghafghazi¹², Umesh Gidwani¹³, Michael Goldfarb¹⁴, Jason N Katz¹⁵, Ellen C Keeley¹⁶, Benjamin Kenigsberg¹⁷, Michael C Kontos¹⁸, Patrick R Lawler¹⁹, Evan Leibner²⁰, Venu Menon²¹, Thomas S Metkus²², P Elliott Miller²³, Connor G O'Brien⁵, Alexander I Papolos¹⁷, Rajnish Prasad²⁴, Kevin S Shah²⁵, Shashank S Sinha²⁶, R Jeffrey Snell²⁷, Derek So²⁸, Michael A Solomon²⁹, Bradley W Ternus³⁰, Jeffrey J Teuteberg³¹, Joseph Toole⁴, Sean van Diepen³², David A Morrow², Robert O Roswell⁴

Affiliations

¹ Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health, New York, New York, USA; Lenox Hospital, Northwell Health, New York, New York, USA. Electronic address: bernard.kadosh@nyulangone.org.
² Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Medicine at New York University Grossman School of Medicine, Bellevue Hospital, New York, New York, USA.
⁴ Lenox Hospital, Northwell Health, New York, New York, USA.
⁵ Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
⁶ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Lehigh Valley Heart Institute, Allentown, Pennsylvania, USA.
⁸ Saint Vincent Heart Center, Indianapolis, Indiana, USA.
⁹ Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA.
¹⁰ Cardiovascular Division, Vanderbilt University, Tennessee, USA.
¹¹ University of British Columbia, University of British Columbia Centre for Cardiovascular Innovation, Cardiovascular Health Program, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada.
¹² Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA.
¹³ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA.
¹⁴ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹⁵ Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁶ Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA.
¹⁷ Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
¹⁸ Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA.
¹⁹ Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada.
²⁰ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA.
²¹ Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
²² Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²³ Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
²⁴ Wellstar Cardiovascular Medicine, Marietta, Georgia, USA.
²⁵ University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
²⁶ Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia, USA.
²⁷ Rush University Medical Center, Chicago, Illinois, USA.
²⁸ University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
²⁹ Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA.
³⁰ Division of Cardiology, Department of Internal Medicine, University of Wisconsin, Madison, Wisconsin, USA.
³¹ Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California, USA.
³² Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 37318422
PMCID: PMC10527413
DOI: 10.1016/j.jchf.2023.04.007

Multicenter Study

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit

Bernard S Kadosh et al. JACC Heart Fail. 2023 Aug.

. 2023 Aug;11(8 Pt 1):903-914.

doi: 10.1016/j.jchf.2023.04.007. Epub 2023 Jun 14.

Authors

Affiliations

¹ Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health, New York, New York, USA; Lenox Hospital, Northwell Health, New York, New York, USA. Electronic address: bernard.kadosh@nyulangone.org.
² Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Medicine at New York University Grossman School of Medicine, Bellevue Hospital, New York, New York, USA.
⁴ Lenox Hospital, Northwell Health, New York, New York, USA.
⁵ Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
⁶ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Lehigh Valley Heart Institute, Allentown, Pennsylvania, USA.
⁸ Saint Vincent Heart Center, Indianapolis, Indiana, USA.
⁹ Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA.
¹⁰ Cardiovascular Division, Vanderbilt University, Tennessee, USA.
¹¹ University of British Columbia, University of British Columbia Centre for Cardiovascular Innovation, Cardiovascular Health Program, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada.
¹² Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA.
¹³ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA.
¹⁴ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹⁵ Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁶ Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA.
¹⁷ Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
¹⁸ Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA.
¹⁹ Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada.
²⁰ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA.
²¹ Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
²² Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²³ Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
²⁴ Wellstar Cardiovascular Medicine, Marietta, Georgia, USA.
²⁵ University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
²⁶ Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia, USA.
²⁷ Rush University Medical Center, Chicago, Illinois, USA.
²⁸ University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
²⁹ Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA.
³⁰ Division of Cardiology, Department of Internal Medicine, University of Wisconsin, Madison, Wisconsin, USA.
³¹ Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California, USA.
³² Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 37318422
PMCID: PMC10527413
DOI: 10.1016/j.jchf.2023.04.007

Abstract

Background: The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.

Objectives: The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.

Methods: The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured.

Results: Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017).

Conclusions: There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care.

Keywords: cardiac intensive care; pulmonary artery catheter; shock.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Solomon has received research support from the National Institutes of Health Clinical Center intramural research funds. Dr Morrow has received research grant support to Brigham and Women’s Hospital from Abbott and Abiomed; and has received consulting fees from Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Figure 1.**
Proportion of admissions with PAC use by primary admission diagnosis. The total length of the bar represents the total proportion of admissions with each diagnosis, with or without shock, with a PAC. Red bars indicate the component for each admitting diagnosis contributed by admissions with shock. PAC: pulmonary artery catheter

**Figure 2.**
Proportion of shock admissions that received a PAC at each participating center. PAC: pulmonary artery catheter

**Figure 3.**
Relationship of PAC use to CS volume and shock severity. A: Correlation between the volume of CS cases per site and the proportion of CS patients receiving PAC. B: Shock severity distribution based on SCAI Shock Stage among CS admissions stratified by quartile of PAC utilization rates at each site. PAC: pulmonary artery catheter, CS: cardiogenic shock, SCAI: Society for Cardiovascular Angiography and Interventions.

**Central Figure.**
Pulmonary Artery Catheter Use in CICUs and Association With Mortality

See this image and copyright information in PMC

Comment in

Accepting the Pulmonary Artery Catheter for Cardiogenic Shock: Escape Past Equipoise?
Siddiqi HK, Rali AS, Stevenson LW. Siddiqi HK, et al. JACC Heart Fail. 2023 Aug;11(8 Pt 1):915-917. doi: 10.1016/j.jchf.2023.05.022. Epub 2023 Jul 5. JACC Heart Fail. 2023. PMID: 37410013 No abstract available.

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Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit

Affiliations

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical