A recent multicenter study conducted by the Critical Care Cardiology Trials Network delved into the utilization of pulmonary artery catheters (PACs) in cardiac intensive care units (CICUs). The study aimed to determine the current prevalence of PAC use, identify factors influencing its utilization, and explore its association with in-hospital mortality rates.
The study examined data from the Critical Care Cardiology Trials Network registry, focusing on patients admitted to American Heart Association level 1 CICUs between September 2017 and September 2021. The analysis included a total of 13,618 CICU admissions across 34 participating sites. Patients admitted for postsurgical recovery or overflow from the medical ICU were excluded from the study.
Key Findings on PAC Utilization and Patient Characteristics
Among the overall CICU population, PACs were utilized in 20% of admissions. The use of PACs increased notably for cases involving shock (45.8%) and cardiogenic shock (55.6%). Multivariable analysis revealed that the strongest patient-level factors associated with PAC use were the need for mechanical circulatory support (MCS) and a primary diagnosis of heart failure (HF). Additional patient-level factors influencing PAC utilization included shock/hypotension, inotrope/vasopressor use, history of HF, pulmonary hypertension, valvular heart disease, and demographic factors.
The study also explored center-specific variations in PAC utilization. The use of PACs in the overall CICU population ranged from 1% to 35%, while in cases of shock, the range extended from 8% to 73%. These findings highlight the impact of center-specific practices on PAC utilization and raise questions about the influence of local protocols and guidelines.
Link Between PAC Use and In-Hospital Mortality Rates
One of the most significant findings of the study was the association between PAC use and lower in-hospital mortality rates for patients with shock in CICUs. Comparing patients who received PACs to those who did not, the former group exhibited a mortality rate of 28.4%, whereas the latter had a mortality rate of 35.0%. This association remained even after adjusting for confounding factors, suggesting a potential benefit of PAC use in this specific patient population.
The study’s findings contribute to the ongoing discussions surrounding the role of PACs in contemporary cardiac intensive care. While PAC utilization varied among centers, the association with reduced mortality in patients with shock suggests the need for further research and exploration of optimal practices. Understanding the patient and center-specific factors influencing PAC use can aid in the development of evidence-based guidelines and protocols for improved patient outcomes.
