Early pulmonary artery catheterization is not associated with survival benefits in critically ill patients with cardiac disease: An analysis of the MIMIC-IV database

Published:August 08, 2022DOI:



      Many studies demonstrated no improved survival in patients with pulmonary artery catheter placement. However, no consistent conclusions have been drawn regarding the impact of pulmonary artery catheter in critically ill patients with heart disease. This study aimed to investigate the association of early pulmonary artery catheter use with 28-day mortality in that population.


      The Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database, a single-center critical care database, was employed to investigate this issue. This study enrolled a total of 11,887 critically ill patients with cardiac disease with or without pulmonary artery catheter insertion. The primary outcome was 28-day mortality. The multivariate regression was modeled to examine the association between pulmonary artery catheter and outcomes. Additionally, we examined the effect modification by cardiac surgeries. Propensity score matching was conducted to validate our findings.


      No improvement in 28-day mortality was observed among the pulmonary artery catheter group compared to the non–pulmonary artery catheter group (odds ratio 95% confidence interval: 1.18 [1.00–1.38], P = .049). When stratified by cardiac surgeries, the results were consistent. The patients in the pulmonary artery catheter group had fewer ventilation-free days and vasopressor-free days than those in the nonpulmonary artery catheter group after surgery stratification. In the surgical patients, pulmonary artery catheter insertion was not associated with the occurrence of acute kidney injury, and it was associated with a higher daily fluid input (mean difference 95% confidence interval: 0.13 [0.05–0.20], P = .001). In nonsurgical patients, the pulmonary artery catheter group had a higher risk of acute kidney injury occurrence (odds ratio 95% confidence interval: 1.94 [1.32–2.84], P = .001).


      Early pulmonary artery catheter placement is not associated with survival benefits in critically ill patients with cardiac diseases, either in surgical or nonsurgical patients.
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        • Swan H.J.
        • Ganz W.
        • Forrester J.
        • Marcus H.
        • Diamond G.
        • Chonette D.
        Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter.
        N Engl J Med. 1970; 283: 447-451
        • Rajaram S.S.
        • Desai N.K.
        • Kalra A.
        • et al.
        Pulmonary artery catheters for adult patients in intensive care.
        Cochrane Database Syst Rev. 2013; : CD003408
        • Binanay C.
        • Califf R.M.
        • Hasselblad V.
        • et al.
        Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.
        JAMA. 2005; 294: 1625-1633
        • Cohen M.G.
        • Kelly R.V.
        • Kong D.F.
        • et al.
        Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials.
        Am J Med. 2005; 118: 482-488
        • Shah M.R.
        • Hasselblad V.
        • Stevenson L.W.
        • et al.
        Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials.
        JAMA. 2005; 294: 1664-1670
        • Friese R.S.
        • Shafi S.
        • Gentilello L.M.
        Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: a National Trauma Data Bank analysis of 53,312 patients.
        Crit Care Med. 2006; 34: 1597-1601
        • Shaw A.D.
        • Mythen M.G.
        • Shook D.
        • et al.
        Pulmonary artery catheter use in adult patients undergoing cardiac surgery: a retrospective, cohort study.
        Perioper Med (Lond). 2018; 7: 24
      1. Brown JA, Aranda-Michel E, Kilic A, et al. The impact of pulmonary artery catheter use in cardiac surgery [e-pub ahead of print]. J Thorac Cardiovasc Surg. doi: Accessed 2 February 2021.

        • Hu H.
        • Li L.
        • Zhang Y.
        • et al.
        A prediction model for assessing prognosis in critically ill patients with sepsis-associated acute kidney injury.
        Shock. 2021; 56: 564-572
      2. Johnson A, Bulgarelli L, Pollard T, Horng S, Celi L, Mark R. MIMIC-IV (version 0.4). PhysioNet; 2020.

        • Zhou S.
        • Zeng Z.
        • Wei H.
        • Sha T.
        • An S.
        Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database.
        Ann Intensive Care. 2021; 11: 42
        • Zhang Z.
        • Kim H.J.
        • Lonjon G.
        • Zhu Y.
        • written on behalf of AMEB- D.C.T.C.G.
        Balance diagnostics after propensity score matching.
        Ann Transl Med. 2019; 7: 16
        • Harvey S.
        • Harrison D.A.
        • Singer M.
        • et al.
        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: 472-477
        • Richard C.
        • Warszawski J.
        • Anguel N.
        • et al.
        Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial.
        JAMA. 2003; 290: 2713-2720
        • Eisenberg P.R.
        • Jaffe A.S.
        • Schuster D.P.
        Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients.
        Crit Care Med. 1984; 12: 549-553
        • Schwann N.M.
        • Hillel Z.
        • Hoeft A.
        • et al.
        Lack of effectiveness of the pulmonary artery catheter in cardiac surgery.
        Anesth Analg. 2011; 113: 994-1002
        • Chiang Y.
        • Hosseinian L.
        • Rhee A.
        • Itagaki S.
        • Cavallaro P.
        • Chikwe J.
        Questionable benefit of the pulmonary artery catheter after cardiac surgery in high-risk patients.
        J Cardiothorac Vasc Anesth. 2015; 29: 76-81
        • Ramsey S.D.
        • Saint S.
        • Sullivan S.D.
        • Dey L.
        • Kelley K.
        • Bowdle A.
        Clinical and economic effects of pulmonary artery catheterization in nonemergent coronary artery bypass graft surgery.
        J Cardiothorac Vasc Anesth. 2000; 14: 113-118
        • Resano F.G.
        • Kapetanakis E.I.
        • Hill P.C.
        • Haile E.
        • Corso P.J.
        Clinical outcomes of low-risk patients undergoing beating-heart surgery with or without pulmonary artery catheterization.
        J Cardiothorac Vasc Anesth. 2006; 20: 300-306
        • Ikuta K.
        • Wang Y.
        • Robinson A.
        • Ahmad T.
        • Krumholz H.M.
        • Desai N.R.
        National trends in use and outcomes of pulmonary artery catheters among Medicare beneficiaries, 1999–2013.
        JAMA Cardiol. 2017; 2: 908-913
        • De Backer D.
        • Vincent J.L.
        The pulmonary artery catheter: is it still alive?.
        Curr Opin Crit Care. 2018; 24: 204-208
        • Hernandez G.A.
        • Lemor A.
        • Blumer V.
        • et al.
        Trends in utilization and outcomes of pulmonary artery catheterization in heart failure with and without cardiogenic shock.
        J Card Fail. 2019; 25: 364-371
        • Vallabhajosyula S.
        • Shankar A.
        • Patlolla S.H.
        • et al.
        Pulmonary artery catheter use in acute myocardial infarction-cardiogenic shock.
        ESC Heart Fail. 2020; 7: 1234-1245
        • Rossello X.
        • Vila M.
        • Rivas-Lasarte M.
        • et al.
        Impact of pulmonary artery catheter use on short- and long-term mortality in patients with cardiogenic shock.
        Cardiology. 2017; 136: 61-69
        • Sionis A.
        • Rivas-Lasarte M.
        • Mebazaa A.
        • et al.
        Current use and impact on 30-day mortality of pulmonary artery catheter in cardiogenic shock patients: results from the CardShock Study.
        J Intensive Care Med. 2020; 35: 1426-1433
      3. Simpson EH. The interpretation of interaction in contingency tables. 1951;13:238–241.

        • Youssef N.
        • Whitlock R.P.
        The routine use of the pulmonary artery catheter should be abandoned.
        Can J Cardiol. 2017; 33: 135-141
        • Wakefield B.
        • Geube M.
        Commentary: the uncertain fate of the pulmonary artery catheter in cardiac surgery: the difference is in the exceptions.
        J Thorac Cardiovasc Surg. 2021;