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September 18, 1996

Is It Time to Pull the Pulmonary Artery Catheter?

Author Affiliations

From the University of Arizona Health Sciences Center, Tucson (Dr Dalen). Dr Bone is Consulting Editor, JAMA.

JAMA. 1996;276(11):916-918. doi:10.1001/jama.1996.03540110070035

Pulmonary artery (PA) catheterization is performed daily in hospitals around the world. The hemodynamic data derived from PA catheterization are used to determine, monitor, and modify therapy in critically ill and/or hemodynamically unstable patients, including those with acute myocardial infarction (MI), congestive heart failure (CHF), and multiorgan failure, and they are frequently used to monitor patients with heart disease who undergo cardiac or noncardiac surgery. More than 1 million PA catheters are sold in the United States each year, and the annual costs associated with the use of PA catheters exceed $2 billion a year.

Despite the widespread use of this procedure and its attendant costs, there is no evidence that it benefits patients. Its use has not been shown to decrease patient morbidity or mortality. To the contrary, there is evidence that it may increase morbidity and mortality.

How Did We Get Here?  Pulmonary artery catheterization was first performed

Dexter L, Haynes FW, Burwell CS, Eppinger EC, Seibel RE, Evans JM.  Studies of congenital heart disease, I: technique of venous catheterization as a diagnostic procedure . J Clin Invest . 1947;26:547-553.Article
Dexter L, Haynes FW, Burwell CS, Eppinger EC, Sagerson RP, Evans JM.  Studies of congenital heart disease, II: the pressure and oxygen content of blood in the right auricle, right ventricle, and pulmonary artery in control patients, with observations on the oxygen saturation and source of pulmonary 'capillary' blood . J Clin Invest . 1947;26:554-560.Article
Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D.  Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter . N Engl J Med . 1970;283:447-451.Article
Gore JM, Goldberg RJ, Spodick DH, Alpert JS, Dalen JE.  A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction . Chest . 1987;92:721-727.Article
Spodick DH.  Flow-directed pulmonary artery catheterization . Chest . 1989;95:489-490.Article
Zion MM, Balkin J, Rosenmann D, et al.  Use of pulmonary artery catheters in patients with acute myocardial infarction: analysis of experience in 5,841 patients in the SPRINT registry . Chest . 1990;98:1331-1335.Article
Guyatt G, and the Ontario Intensive Care Study Group.  A randomized control trial of right-heart catheterization in critically ill patients . J Intensive Care Med . 1991;6:91-95.
Connors AF, Speroff T, Dawson NV, et al.  The effectiveness of right heart catheterization in the initial care of critically ill patients . JAMA . 1996;276:889-897.Article
Coalition for Critical Care Excellence.  Standards of evidence for the safety and effectiveness of critical care monitoring devices and related interventions . Crit Care Med . 1995;23:1756-1763.Article