Fatal pulmonary hemorrhage complicating use of a flow-directed balloon-tipped catheter in a patient receiving anticoagulant therapy

Golden, Michael S.; Pinder, Thomas; Anderson, Warren T.; Cheitlin, M.D.

doi:10.1016/s0002-9149(73)80019-0

Cited by 78 publications

(12 citation statements)

References 6 publications

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“…Rupture of the pulmonary artery is generally viewed as the most serious complication associated with use of balloon-tipped pulmonary arterial catheters. To our knowledge, 29 cases have been reported in the literature between 1971 and 1982 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Forty-five percent of these were fatal.…”

mentioning

confidence: 99%

Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Hardy

Morissette

Taillefer

et al. 1983

Anesthesia & Analgesia

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of rupture of the pulmonary artery by pulmonary artery balloon-tipped catheters. Anesth Analg 1983;62:925-30. High pressures have been reported in pulmonary artery catheter balloons. This study was undertaken to determine the in vitro rupturing pressures of human peripheral pulmonary arteries and to evaluate whether such pressures could be generated under clinical conditions. The in vitro model then was confirmed in vivo in the dog and the evolution of a rupture of a peripheral pulmonary artery studied. In vitro, pulmonary arteries of subjects under age 60 yr are remarkably resistant and tolerate intra-balloon pressures of 2700 mm Hg in the one mid-pulmonary artery studied and up to 4219 k 720 mm Hg (mean 5 SD) in the distal pulmonary artery. Subjects over the age of 60 yr have significantly lower rupturing pressures (1965 * 540 mm Hg in the mid-pulmonary artery, and 2498 2 600 mrn Hg in the distal pulmonary artery), (P < 0.05). Thus overdistension by the balloon may explain most ruptures. Preexisting pulmonary hypertension did not affect in vitro rupturing pressures. Clinicians generated intraballoon mean pressures of 795 ? 130 mm Hg, with 20% of them generating higher and potentially dangerous pressures (1000 mm Hgor more). The in vitro model was confirmed by in vivo studies in dogs with pressures that cause pulmonary artery rupture. Furthermore, in normal dogs, rupture of a peripheral pulmonary artery was without complications. This suggests that rupture of the peripheral pulmonary artery may occur clinically more frequently than reported. The user of flotation pulmonary arterial catheters should be aware of the dangers associated with this diagnostic tool. In particular, liquids must never be used to inflate pulmonary arterial catheter balloons.

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mentioning

confidence: 99%

Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Hardy

Morissette

Taillefer

et al. 1983

Anesthesia & Analgesia

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“…A recent case of fatal pulmonary hemorrhage in an anticoagulated patient was attributed to inflation of a balloon-tipped catheter within a distal pulmonary arterial branch (5). The mechanism of vascular damage closely resembled that responsible for these artifactual measurements.…”

Section: Discussionmentioning

confidence: 89%

Potential artifact in measurement of left ventricular filling pressure with flow‐directed catheters

Meister

Engel

Fischer

et al. 1976

Cathet. Cardiovasc. Diagn.

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Artifactual pulmonary wedge pressure measurements were encountered during bedside use of Swan-Ganz catheters. These values were higher than pulmonary artery end diastolic pressure and devoid of typical phasic contours. Utilizing fluoroscopy these artifacts were reproduced by advancing the catheter tip 2-4 cm beyond the site of initial wedging and reinflating the balloon. Spurious increases of pulmonary wedge pressure of up to 15 mm Hg were thus obtained. In vitro catheter testing demonstrated overlapping of the catheter tip by the deformed balloon when it was fully inflated in a channel too small to accomodate it. These measurement artifacts are thus attributed to distal migration of the catheter tip into relatively small pulmonary artery branches and to subsequent occlusion of the catheter lumen by the balloon when it is reinflated. This can readily be avoided by routinely inflating the balloon with the minimum volume of air sufficient to yield a pulmonary wedge pressure tracing.

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“…Although five previous cases of pulmonary artery perforation have been reported (Chun and Ellestad, 1971;Lapin et al, 1972;German et al, 1973;Golden et al, 1973;Page et al, 1974), the factors involved in these perforations by balloontipped catheters are unclear. Several predisposing factors have been emphasised; pulmonary hypertension (German et al, 1973), an excessively peripheral location of the catheter (Chun and Ellestad, 1971), a large loop of catheter in the right atrium or right ventricle which may allow the tip to perforate the pulmonary wall secondary to catheter motion (Chun and Ellestad, 1971), and anticoagulation (Golden et al, 1973).…”

Section: Commentmentioning

confidence: 99%

“…The common complications associated with their insertion are usually not severe and have not been associated with lethal consequences (Foote et al, 1974;Katz et al, 1977). Major complications have been described, among which are five cases of pulmonary artery perforation, two of them fatal (Chun and Ellestad, 1971;Lapin and Murray, 1972;German et al, 1973;Golden et al, 1973;Page et al, 1974).…”

mentioning

confidence: 99%

Perforation of the pulmonary artery requiring pneumonectomy after the use of a flow-directed (Swan-Ganz) catheter

Deren

Barash

Hammond

et al. 1979

Thorax

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Fatal pulmonary hemorrhage complicating use of a flow-directed balloon-tipped catheter in a patient receiving anticoagulant therapy

Cited by 78 publications

References 6 publications

Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Potential artifact in measurement of left ventricular filling pressure with flow‐directed catheters

Perforation of the pulmonary artery requiring pneumonectomy after the use of a flow-directed (Swan-Ganz) catheter

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