Sandham JD, Hull RD, Brant RF et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. New England Journal of Medicine 2003; 348: 5-14.
RHH Journal Club. May 23th, 2013. Dr Kris Sivarajan
Full-text article (if available)
Does the use of a PA catheter improve in hospital mortality in surgical patients?
- Multicentre Randomised Control Trial
- Canadian Hospitals
- >60yrs old
- ASA III or IV
- Elective or urgent Major Surgery
- Randomised to PAC or standard care
- PAC inserted prior to surgery
- Set aims and intervention with fixed priority
- 24 hr ICU stay
- In hospital mortality of any cause
- 6 or 12 month mortality
- In hospital morbidity
- Did groups start with a similar prognosis? Yes
- Numbers involved: 997 standard care, 997 PAC. Eligible 3803
- Randomisation – concealed
- Blinded – Observers blinded to intervention
- Intention to treat principle applied.
- Follow up complete similar numbers lost to follow up.
- No difference in hospital mortality
- No difference 6/12 month mortality
- No difference morbidity except PE – 7pts PAC group 0 standard care
Take home message/application of this research:
- No benefit to PAC in general surgical patients
- Potential for further large number studies with PA catheters