Pulmonary artery catheters in cardiovascular surgery

Abstract

In summary, Jacka et al. have done us a service by helping to define clinicians' attitudes regarding the appropriateness of PAC use. Meanwhile, cardiovascular anesthesiologists continue to make decisions regarding PAC use in the absence of high-quality evidence regarding efficacy. The PAC continues to be widely employed in low-risk patients undergoing high frequency procedures like CABG and AAR. Because PAC use is not without cost or risk well-designed RCTs conducted in these populations would be emtremely helpful. The essential characteristics of a meaningful RCT have been well described. These include a large sample size, protocol-guided treatment responses to PAC-derived data, elimination of crossover from CVP to PAC groups, and a focus on clinically relevent outcomes. The survey by Jacka et al. suggests to me that it would be ethical to conduct multicentre RCT examining the utility of PAC use in patients without severe LV dysfunction, with or without unstable angina, undergoing CABG. I believe such a study would also be feasibel, and fundable.