Thursday February 16, 2006
PAC-MAN study !
Benefits of pulmonary artery catheter (PAC) are debatable in Critical Care. Last year ESCAPE trial 2 failed to show any benefit. Untill we get results of FACTT trial (ARDSnet), lets have a look on PAC-MAN study. (Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care) published in Lancet, last year (august 2005 issue). 1 This is one of the largest study of 1013 patients in this regard. Patients were compared to management with (n = 506) or without (n = 507) a PAC with primary end-point of hospital mortality. No difference in hospital mortality between subjects managed with or without a PAC was noted - 68% vs 66%. Complications associated with insertion of a PAC were noted in 46 of 486 patients but none were considered fatal.
In subsets analysis, of patients randomized to receive either a PAC or no monitor of cardiac output, mortality was 71% [75 of 105] vs. 66% [71 of 107] and of patients randomized in ICUs allowing the possibility of an alternative monitor of cardiac output, mortality was 68% [271 of 401] vs. 66% [262 of 400].
In conclusion, there was no clear evidence of benefit or harm in managing critically ill patients with a PAC.
Related previous pearl: ESCAPE Trial - setback to swan lovers?
References: Click to get abstract/article (secondpopup override first popup)
1. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial - Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton W, Williams D, Young D, Rowan K, The Lancet - Vol. 366, Issue 9484, 06 August 2005, Pages 472-477 - (abstract-review printed at cleveland clinic journal of medicine, november 2005 page 1048)
2. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness - JAMA. 2005;294:1625-1633.
3. Impact of the Pulmonary Artery Catheter in Critically Ill Patients -JAMA. 2005;294:1664-1670.