Depth of Anesthesia 41: Do pulmonary artery catheters improve outcomes in cardiac surgery?
Oct 26, 2025
Dr. Taylor Thomas, a dual fellow in obstetric and adult cardiothoracic anesthesia, and Dr. Matt Vanneman, a Clinical Associate Professor at Stanford, delve into the controversial use of pulmonary artery catheters (PACs) in cardiac surgery. They discuss the significant findings from studies showing no mortality benefit but potential harm in lower-risk patients. Intriguingly, they explore how PACs may aid management in cardiogenic shock patients. The conversation highlights the need for randomized trials to clarify their efficacy in various surgical contexts.
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Training Shows Wide PAC Practice Variation
- Taylor recalls wide variability in PAC use across attendings and institutions during training.
- That variability motivated her to examine the evidence behind the practice.
PAC Use Linked To Worse Outcomes In Large Cohort
- A large prospective cohort (Schumann et al.) found PAC use linked to higher major morbidity and mortality after CABG.
- The study suggests monitoring alone may not improve outcomes and might prompt interventions that worsen results.
Confounding And Action Cascades Matter
- Propensity matching reduces confounding but cannot adjust for unmeasured variables, so observational PAC studies risk residual confounding.
- The catheter likely influences clinician behavior, prompting interventions that may drive observed harm.