Video Fluoroscopy for Positioning of Pulmonary Artery Catheters in Patients Undergoing Cardiac Surgery

Abstract

Objectives To determine whether video fluoroscopy combined with traditional pressure waveform analyses facilitates optimal pulmonary artery catheter (PAC) flotation and final positioning compared with the traditional pressure waveform flotation technique alone. Design Prospective, single-center, randomized, controlled trial. Setting Single-center university teaching hospital. Participants The study included 50 cardiac surgery patients at higher risk for PAC complications. Interventions Use of video fluoroscopy to facilitate optimal PAC flotation and positioning. Measurements and Main Results The primary outcome was the time taken to float and position the PAC balloon in the pulmonary artery as confirmed by transesophageal echocardiography. Secondary outcomes included number of attempts at flotation, ventricular rhythm disturbances, and catheter malposition. Patients were evenly matched in baseline demographics, New York Heart Association symptoms of heart failure, severity of left and right ventricular dysfunction, end-diastolic pressures and dimensions, severity of tricuspid valvular disease, and atrial and pulmonary artery pressures. Mean (SD) time to float the PAC was significantly shorter in the video fluoroscopy group than in the usual care group: 73 seconds (SD, 65.1) versus 176 seconds (SD, 180.6), respectively; p = 0.014. The median (interquartile range [IQR]) number of attempts to successful flotation was fewer in the video fluoroscopy group than in the usual care group: 1 (IQR 1:2) attempt versus 2 (IQR 1:4) attempts, respectively; p = 0.007. The composite complication rate (malposition and arrhythmias) was lower in the video fluoroscopy group than in the usual care group (16% v 52%, respectively; p = 0.01). Conclusions In cardiac surgery patients at higher risk for PAC complications, video fluoroscopy facilitated faster and safer catheter flotation and positioning compared with the traditional pressure waveform flotation technique.