Assessment of the Clinical Effectiveness of Pulmonary Artery Catheters in Management of Patients in Intensive Care (PAC-MAN)

Summary by Alain Harb MD, 11.3.22
https://pubmed.ncbi.nlm.nih.gov/16084255/


Take Home Point:

  • There was no benefit found from the routine use of a PAC

  • Complications occurred in 10% of PACs

    • Although some of these may have been avoided with the use of ultrasound.

  • Subgroup analysis showed no benefit in any ‘major presumptive clinical syndrome,’ however like with all studies, subgroup analyses were not sufficiently powered to give us the definite answer.

Historically, most ICUs that took part in the study used PACs frequently. Current practice means that ICU use of PACs are very infrequent, much less than 5% which was the cut-off in the study for ‘low use of PAC’. With unfamiliarity, the benefits of PAC use may be outweighed by the potential complications.

 

Summary

Background: Over the past 30 years the pulmonary artery catheter (PAC) has become a widely used hemodynamic monitoring device in the management of critically ill patients, though doubts exist about its safety. Our aim was, therefore, to ascertain whether hospital mortality is reduced in critically ill patients when they are managed with a PAC.

Methods: Randomized controlled trial to with1041 patients from 65 UK intensive care units. Individuals were assigned to management with (n=519) or without (n=522) a PAC. The timing of insertion and subsequent clinical management were at the discretion of the treating clinician. Intensive care units decided a priori to have the option of using an alternative cardiac output-monitoring device in control patients.

Results: 1014 patients were eligible for analysis. No difference in hospital mortality between patients managed with or without a PAC (68% [346 of 506] vs 66% [333 of 507], p=0·39; adjusted hazard ratio 1·09, 95% CI 0·94–1·27). Complications associated with insertion of a PAC in 46 of 486 individuals in whom the device was placed, none of which was fatal. 

Discussion: These findings indicate no clear evidence of benefit or harm by managing critically ill patients with PAC. Efficacy studies are needed to ascertain whether management protocols involving PAC use can result in improved outcomes in specific groups if these devices are not to become a redundant technology.