Clinical Question:
Are pulmonary artery catheters useful in the management of critically ill patients?

Bottom Line:
In critically ill patients, use of the PAC neither increased overall mortality or days in hospital nor conferred benefit. Despite almost 20 years of RCTs, a clear strategy leading to improved survival with the PAC has not been devised. The neutrality of the PAC for clinical outcomes may result from the absence of effective evidence-based treatments to use in combination with PAC information across the spectrum of critically ill patients.

Reference:
Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients. Meta-analysis of randomized clinical trials. JAMA 2005;294:1664-70.

Study Design:
Meta-analysis (randomized controlled trials)

Synopsis:
Although the PAC is widely used in the management of critically ill patients, data regarding the utility of this device are conflicting. The investigators thoroughly searched MEDLINE, the Cochrane Controlled Trials Registry, bibliographies of identified articles, and government databases for English language randomized trials evaluating the effectiveness of PAC in various clinical settings. Two independent reviewers assessed the eligibility of individual trials and abstracted data in an unblinded manner. Disagreements were resolved by consensus. A total of 13 randomized trials involving 5051 patients met inclusion criteria for both methodology and quality. The meta-analysis also included a trial published in the same journal issue (The ESCAPE Trial. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness. JAMA 2005;294:1625-33). Compared with clinical management alone, PAC use did not significantly affect mortality. Furthermore, the PAC did not significantly reduce days of hospitalization. The PAC is associated with an increased use of inotropic medications and vasodilators. The investigators did not perform a formal analysis for publication bias. The overall findings of all trials were homogeneous (ie, the results were similar among the individual trials).