The pulmonary artery catheter is a device used to measure blood flow and pressures in the heart and lung blood vessels. These measurements are used to guide treatment of critically ill patients or patients undergoing major surgery. Pulmonary artery catheters were first used in intensive care units about 30 years ago, but there is no clear evidence that using them to guide treatment actually allows patients to recover faster, or for more of them to survive their illness.
Twelve trials were identified comparing patients treated with and without the use of a pulmonary artery catheter. These were divided into trials of patients undergoing routine major surgery and trials of patients who were critically ill and admitted to intensive care for more wide-ranging reasons. There were eight trials in the major surgery group and only one was a large trial with nearly 2000 patients. The other trials were conducted in single hospitals and had no more than 120 patients taking part. There were four trials of critically ill patients, and two were large trials: one with nearly 700 patients and one with over 1000 patients. Overall, even though the trials measured numbers of deaths in each group at different points in time, all reported that there were no differences between patients who did and did not have a pulmonary artery catheter inserted. Five trials also measured the costs associated with using a pulmonary artery catheter. Four trials were conducted in the US and showed that on average the charges were higher for patients who had a pulmonary artery catheter. A study in the UK used a different approach to analyse costs of care and concluded that withdrawing the use of the pulmonary artery catheter might result in a cost saving.
Most of the trials identified were small, conducted in a single hospital with less than 200 patients taking part. Most were of patients undergoing routine major surgery. Neither group of patients studied showed any evidence of benefit or harm from a pulmonary artery catheter.