PAC-Man: Pulmonary artery catheters for adult intensive care patients

Background

Over the past 30 years the pulmonary artery catheter (PAC) – a device used in the management of critically ill patients by measuring how well the heart is functioning – has become a widely used haemodynamic monitoring device in the management of critically ill patients. However, there are doubts about it’s safety. The aim of the PAC-Man study was, therefore, to find out if using a PAC to manage critically ill patients leads to a reduction in the number of deaths in hospital.

Design

The PAC-Man Study was a multicentre randomised controlled trial which enrolled patients from 65 UK intensive care units.  Patients were randomly allocated to management with or without a PAC.  The timing of insertion and subsequent clinical management were at the discretion of the treating doctor. 

Results

1014 patients were enrolled into the trial. We found no difference in hospital mortality between patients managed with or without a PAC (68% vs 66%, p=0·39; adjusted hazard ratio 1·09, 95% CI 0·94–1·27). Complications directly related to use of a PAC were reported for 10% of patients in whom insertion of a PAC was attempted. None of the complications were fatal.

Conclusion

Our findings indicate no clear evidence of benefit or harm by managing critically ill patients with a PAC. Further studies are needed to establish whether managing patients with a PAC can be effective in improving outcomes in specific patient groups. Otherwise, these devices may become an unnecessary technology.



Who led the study? 

Professor Kathy Rowan, ICNARC

The study was funded by the National Institute for Health Technology (NIHR) – Health Technology Assessment (HTA) Programme (Project: 97/08/03)

Publications

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev 2013; 2:CD003408. http://dx.doi.org/10.1002/14651858.CD003408.pub3

Harvey SE, Welch CA, Harrison DA, Rowan KM, Singer M. Post hoc insights from PAC-Man--the U.K. pulmonary artery catheter trial. Crit Care Med 2008; 36(6):1714-21. http://dx.doi.org/10.1097/CCM.0b013e318174315d

Harvey SE, Elbourne D, Ashcroft J, Jones CM, Rowan K. Informed consent in clinical trials in critical care: experience from the PAC-Man Study. Intensive Care Med 2006; 32(12):2020-5.

Harvey S, Young D, Brampton W, Cooper AB, Doig G, Sibbald W, Rowan K. Pulmonary artery catheters for adult patients in intensive care. Anesth Analg 2006; 103(6):1577.

Harvey S, Stevens K, Harrison D, Young D, Brampton W, McCabe C, Singer M, Rowan K. An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: a systematic review and a randomised controlled trial. Health Technol Assess 2006; 10(29):1-150.

Harvey S, Singer M. Managing critically ill patients with a pulmonary artery catheter. Br J Hosp Med (Lond) 2006; 67(8):421-6. http://dx.doi.org/10.12968/hmed.2006.67.8.21977

Stevens K, McCabe C, Jones C, Ashcroft J, Harvey S, Rowan K. The incremental cost effectiveness of withdrawing pulmonary artery catheters from routine use in critical care. Appl Health Econ Health Policy 2005; 4(4):257-64.

Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton W, Williams D, Young D, Rowan K. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet 2005; 366(9484):472-7.