Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock

Abstract

Objectives: The impact of pulmonary artery catheterization (PAC) on survival in patients with cardiogenic shock (CS) is not well established. This study aimed to assess whether Swan-Ganz catheter monitoring is related to short- and long-term mortality in patients with CS. Methods: One hundred and twenty-nine consecutive patients with a first admission for CS were prospectively enrolled in a single-center registry between December 2005 and May 2009, and were subsequently followed up over 5.3 years. Results: PAC was used in 64% of all patients with a mean age of 68 years (65% men). After adjustment for age, gender and the presence of CS upon admission, PAC was associated with lower short-term mortality [hazard ratio (HR) = 0.55, 95% confidence interval (CI) 0.35-0.86, p = 0.008] as well as lower mortality rates in the long-term follow-up (HR = 0.63, 95% CI 0.41-0.97, p = 0.035). In a subgroup analysis, the use of PAC was associated with reduced mortality in patients without acute coronary syndrome (ACS), i.e. 49% in the Swan-Ganz group vs. 82% (p = 0.010), but there was no difference within the ACS group. Conclusions: The use of PAC in patients with CS was associated with lower short- and long-term mortality rates after adjustment for age, gender and the presence of shock upon admission. This benefit was only significant in those patients without ACS.

Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A prospective randomized study

“…Pulmonary artery catheterization, also known as Swan-Ganz catheter, has been accepted as a gold standard for the clinical measurement of cardiac output for more than 20 years, and it is an important hemodynamic monitoring tool for critically ill patients to guide diagnosis and treatment. However, its use has progressively declined due to difficulties in data interpretation and the potential development of serious complications[19,20]. Doppler echocardiography has become a standard imaging modality for the assessment of cardiac pumping function, and can provides a number of non-invasive hemodynamic measurements.…”

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

“…198 Lastly, although clinical trials have shown no benefit with the routine use of PAC hemodynamic monitoring, observational studies in CS populations have been mixed, and the PAC remains a potentially important diagnostic and management tool for these individuals. [199][200][201][202] Hemodynamic data provided by a PAC can confirm the presence and severity of CS, involvement of the RV, pulmonary artery pressures and transpulmonary gradient, and vascular resistance of the pulmonary and systemic arterial beds. In addition, a PAC may provide CS prognostic information such as CI and cardiac power and enables clinicians to monitor responses to therapeutic interventions.…”

‚Combat‛ Approach to Cardiogenic Shock

“…catheterisation in all-comers in the intensive care unit has proven ineffective, such detailed invasive haemodynamic data are essential for optimal management of CS, particularly when percutaneous MCS devices are used. [78][79][80][81][82][83][84] In the limitations inherent to each device. [93][94][95][96][97][98][99] In the cardiac or cardiothoracic surgery intensive care unit, patients These data support our hypothesis that team-based multidisciplinary care, haemodynamic guidance and early consideration of MCS improve survival in patients with AMI or ADHF CS.…”