Obituary: pulmonary artery catheter 1970 to 2013

Abstract

The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. This was followed by randomized controlled trials demonstrating he was of little use. Furthermore, reports surfaced suggesting that he was unreliable and inaccurate. It also became clear that he was poorly understood and misinterpreted. Pretty soon after that, a posse of rivals (bedside echocardiography, pulse contour technology) moved into the neighborhood and claimed they could assess cardiac output more easily, less invasively and no less reliably. To make matter worse, dynamic assessment of fluid responsiveness (pulse pressure variation, stroke volume variation and leg raising) made a mockery of his ‘wedge’ pressure. While a handful of die-hard followers continued to promote his mission, the last few years of his existence were spent as a castaway until his death in 2013. His cousin (the continuous cardiac output PAC) continues to eke a living mostly in cardiac surgery patients who need central access anyway. This paper reviews the rise and fall of the conventional PAC.

The efficacy of bedside chest ultrasound: from accuracy to outcomes

“…There are also opportunity costs consumed by sonographic training, capital investment and scarce bedside time with patients. The rise and fall of the pulmonary artery catheter offers a cautionary tale of a test implemented beyond its evidence base [145,146]. Concerns regarding possible increased mortality have now limited its routine use, although it is still believed to have a role in specific instances.…”

Perioperative Haemodynamic Optimisation

“…However, as long as the PAC was used, several types of complications were reported (69,70) and in some cases the data obtained was poorly understood and misinterpreted (71). Some studies using PAC to guide haemodynamic optimisation yield conflicted evidence (72,73).…”

The Pulmonary Circulation

“…The clinical use of the PA catheter has been criticized because of patient safety issues and questionable precision. 9,11 However, the experience from our group of using Arrow (Arrow Int. ; Teleflex Medical, Reading, PA) and Edwards Swan-Ganz (Edwards Lifesciences, Irvine, CA) PA thermodilution catheters in vitro (i.e., bench test rig) and in vivo (i.e., anesthetized pig model) was that the PA thermodilution catheter itself was a very well-made and accurate device.…”