Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit
The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated. The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and e...
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| Published in: | JACC. Heart failure Vol. 11; no. 8 Pt 1; p. 903 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01.08.2023
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| ISSN: | 2213-1787, 2213-1787 |
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| Abstract | The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.
The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.
The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured.
Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017).
There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care. |
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| AbstractList | The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.
The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.
The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured.
Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017).
There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care. The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.BACKGROUNDThe appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.OBJECTIVESThe authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured.METHODSThe Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured.Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017).RESULTSAmong 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017).There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care.CONCLUSIONSThere is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care. |
| Author | Katz, Jason N Ternus, Bradley W Kenigsberg, Benjamin Miller, P Elliott Metkus, Thomas S Goldfarb, Michael So, Derek Barnett, Christopher F O'Brien, Connor G Shah, Kevin S Solomon, Michael A Alviar, Carlos van Diepen, Sean Kadosh, Bernard S Chaudhry, Sunit-Preet Snell, R Jeffrey Kontos, Michael C Prasad, Rajnish DeFilippis, Andrew Fordyce, Christopher B Roswell, Robert O Ghafghazi, Shahab Park, Jeong-Gun Papolos, Alexander I Gidwani, Umesh Sinha, Shashank S Alzate, James Berg, David D Menon, Venu Teuteberg, Jeffrey J Morrow, David A Daniels, Lori B Keeley, Ellen C Barsness, Gregory W Toole, Joseph Burke, James Baird-Zars, Vivian M Lawler, Patrick R Delicce, Anthony Bohula, Erin A Leibner, Evan |
| Author_xml | – sequence: 1 givenname: Bernard S surname: Kadosh fullname: Kadosh, Bernard S email: bernard.kadosh@nyulangone.org organization: Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health, New York, New York, USA; Lenox Hospital, Northwell Health, New York, New York, USA. Electronic address: bernard.kadosh@nyulangone.org – sequence: 2 givenname: David D surname: Berg fullname: Berg, David D organization: Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA – sequence: 3 givenname: Erin A surname: Bohula fullname: Bohula, Erin A organization: Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA – sequence: 4 givenname: Jeong-Gun surname: Park fullname: Park, Jeong-Gun organization: Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA – sequence: 5 givenname: Vivian M surname: Baird-Zars fullname: Baird-Zars, Vivian M organization: Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA – sequence: 6 givenname: Carlos surname: Alviar fullname: Alviar, Carlos organization: Department of Medicine at New York University Grossman School of Medicine, Bellevue Hospital, New York, New York, USA – sequence: 7 givenname: James surname: Alzate fullname: Alzate, James organization: Lenox Hospital, Northwell Health, New York, New York, USA – sequence: 8 givenname: Christopher F surname: Barnett fullname: Barnett, Christopher F organization: Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA – sequence: 9 givenname: Gregory W surname: Barsness fullname: Barsness, Gregory W organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA – sequence: 10 givenname: James surname: Burke fullname: Burke, James organization: Lehigh Valley Heart Institute, Allentown, Pennsylvania, USA – sequence: 11 givenname: Sunit-Preet surname: Chaudhry fullname: Chaudhry, Sunit-Preet organization: Saint Vincent Heart Center, Indianapolis, Indiana, USA – sequence: 12 givenname: Lori B surname: Daniels fullname: Daniels, Lori B organization: Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA – sequence: 13 givenname: Andrew surname: DeFilippis fullname: DeFilippis, Andrew organization: Cardiovascular Division, Vanderbilt University, Tennessee, USA – sequence: 14 givenname: Anthony surname: Delicce fullname: Delicce, Anthony organization: Lenox Hospital, Northwell Health, New York, New York, USA – sequence: 15 givenname: Christopher B surname: Fordyce fullname: Fordyce, Christopher B organization: University of British Columbia, University of British Columbia Centre for Cardiovascular Innovation, Cardiovascular Health Program, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada – sequence: 16 givenname: Shahab surname: Ghafghazi fullname: Ghafghazi, Shahab organization: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA – sequence: 17 givenname: Umesh surname: Gidwani fullname: Gidwani, Umesh organization: Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA – sequence: 18 givenname: Michael surname: Goldfarb fullname: Goldfarb, Michael organization: Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada – sequence: 19 givenname: Jason N surname: Katz fullname: Katz, Jason N organization: Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA – sequence: 20 givenname: Ellen C surname: Keeley fullname: Keeley, Ellen C organization: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA – sequence: 21 givenname: Benjamin surname: Kenigsberg fullname: Kenigsberg, Benjamin organization: Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA – sequence: 22 givenname: Michael C surname: Kontos fullname: Kontos, Michael C organization: Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA – sequence: 23 givenname: Patrick R surname: Lawler fullname: Lawler, Patrick R organization: Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada – sequence: 24 givenname: Evan surname: Leibner fullname: Leibner, Evan organization: Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA – sequence: 25 givenname: Venu surname: Menon fullname: Menon, Venu organization: Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA – sequence: 26 givenname: Thomas S surname: Metkus fullname: Metkus, Thomas S organization: Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA – sequence: 27 givenname: P Elliott surname: Miller fullname: Miller, P Elliott organization: Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA – sequence: 28 givenname: Connor G surname: O'Brien fullname: O'Brien, Connor G organization: Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA – sequence: 29 givenname: Alexander I surname: Papolos fullname: Papolos, Alexander I organization: Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA – sequence: 30 givenname: Rajnish surname: Prasad fullname: Prasad, Rajnish organization: Wellstar Cardiovascular Medicine, Marietta, Georgia, USA – sequence: 31 givenname: Kevin S surname: Shah fullname: Shah, Kevin S organization: University of Utah Health Sciences Center, Salt Lake City, Utah, USA – sequence: 32 givenname: Shashank S surname: Sinha fullname: Sinha, Shashank S organization: Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia, USA – sequence: 33 givenname: R Jeffrey surname: Snell fullname: Snell, R Jeffrey organization: Rush University Medical Center, Chicago, Illinois, USA – sequence: 34 givenname: Derek surname: So fullname: So, Derek organization: University of Ottawa Heart Institute, Ottawa, Ontario, Canada – sequence: 35 givenname: Michael A surname: Solomon fullname: Solomon, Michael A organization: Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA – sequence: 36 givenname: Bradley W surname: Ternus fullname: Ternus, Bradley W organization: Division of Cardiology, Department of Internal Medicine, University of Wisconsin, Madison, Wisconsin, USA – sequence: 37 givenname: Jeffrey J surname: Teuteberg fullname: Teuteberg, Jeffrey J organization: Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California, USA – sequence: 38 givenname: Joseph surname: Toole fullname: Toole, Joseph organization: Lenox Hospital, Northwell Health, New York, New York, USA – sequence: 39 givenname: Sean surname: van Diepen fullname: van Diepen, Sean organization: Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada – sequence: 40 givenname: David A surname: Morrow fullname: Morrow, David A organization: Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA – sequence: 41 givenname: Robert O surname: Roswell fullname: Roswell, Robert O organization: Lenox Hospital, Northwell Health, New York, New York, USA |
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| Snippet | The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.
The authors aimed to characterize the current use... The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.BACKGROUNDThe appropriate use of pulmonary artery... |
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| SubjectTerms | Catheters Heart Failure - therapy Hospital Mortality Hospitalization Humans Intensive Care Units Pulmonary Artery |
| Title | Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit |
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