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December 19, 2001

Does Right Heart Catheterization Prevent Perioperative Complications?

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(23):2940-2941. doi:10.1001/jama.286.23.2940

To the Editor: The study by Dr Polanczyk and colleagues1 of postoperative complications associated with RHC emphasizes the lack of randomized controlled trials (RCTs) of this serious intervention. In 1980, I urged that such trials be completed before "the genie gets out of the bottle."2 The genie has escaped. Wholesale commitment to RHC on faith alone has made performing RCTs of this technology difficult. For instance, in a Canadian trial,3 35% of patients were excluded because their physicians considered it unethical not to insert a catheter. Similarly, in the original Coronary Artery Surgery Study trial of coronary artery bypass, two thirds of the patient refusals were at the behest of their personal physicians.4 The actual breach of ethics is in not performing RCTs, which give the earliest candidates a 50-50 chance not to get new and unproved procedures.4