The pulmonary artery catheter – a personal view

The pulmonary artery catheter (PAC) was introduced into critical care medicine without objective evidence of its efficacy. The direct risks from the PAC are around 1.5% for a serious complication and 0.2% for death.
The Connors study on 5,735 intensive care patients used case-matching techniques, and demonstrated a worse outcome in the PAC cohort. However, in this study the need for inotropes and the response to treatment were excluded from the regression analysis. Three further studies have failed to show an association between PAC placement and outcome after case-mix adjustment.
It has proved extremely difficult to recruit enough intensive care patients to exclude a clinically important mortality benefit of the PAC.
New techniques such as the oesophageal Doppler, pulse contour continuous cardiac output and lithium dilution cardiac output machines offer simpler, and perhaps better, alternatives to the PAC. Nonetheless, even if future trials are negative, the PAC should remain available for treatment of patients with unusual conditions or combinations of conditions.