FREQUENCY, INDICATIONS AND COMPLICATIONS OF PULMONARY ARTERY CATHETER INSERTION IN ADULT OPEN-HEART SURGERY PATIENTS OF A TERTIARY CARE HOSPITAL

Authors

  • Syed Shabbir Ahmed Aga Khan University Hospital Karachi
  • Mohammad Irfan Akhtar Aga Khan University Hospital Karachi
  • Rehana Kamal Aga Khan University Hospital

Abstract

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients. Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital for a period of six months from Nov 2015 to April 2016.Two hundred and seven patients were included in this study. PAC was inserted through right/left internal jugular vein or subclavian vein. Complications noted were arrhythmias (atrial and ventricular), right bundle branch block, coiling and knotting, pulmonary artery rupture, and infection up to 72 hours of PAC insertion. Frequency and percentage were computed for gender, comorbids (Hypertension, Diabetes, Chronic kidney disease, Chronic Obstructive Pulmonary Disease) and PAC frequency of insertion, indications and complications were noted. Results: The frequency of PAC insertion was 47.83%. Major indications for PAC insertion were poor left ventricular function, acute coronary syndrome, cardiogenic shock, significant left main disease and valvular heart disease patients. Minor complications were found in 23.22% cases, which included arrhythmia in 19.2% cases and coiling in 4.02%. Conclusion: Pulmonary artery catheter insertion is a safe technique with useful clinical application in the management of high-risk cardiac surgical patients. The PAC insertion rationale must be standardized to confirm the judicious use.Keywords: Pulmonary artery catheter (PAC) insertion; Adult cardiac surgery; Complications

Author Biographies

Syed Shabbir Ahmed, Aga Khan University Hospital Karachi

Fellow Cardiothoracic AnaesthesiaDepartment of AnaesthesiologyAga Khan University HospitalKarachi 

Mohammad Irfan Akhtar, Aga Khan University Hospital Karachi

Assistant ProfessorDepartment of AnaesthesiologyAga Khan University HospitalKarachi

Rehana Kamal, Aga Khan University Hospital

ProfessorDepartment of AnaesthesiologyAga Khan University HospitalKarachi

References

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Daniels JP, Ansermino JM. Introduction of new monitors into clinical anesthesia. Curr Opin Anaesthesiol. 2009;22(6):775-81.

Practice guidelines for pulmonary artery catheterization: an updated report by the American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization. Anesthesiology. 2003;99(4):988-1014.

Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112(6):1392-402.

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev. 2013;2:CD003408.

Schwann NM, Hillel Z, Hoeft A, Barash P, Mohnle P, Miao Y, et al. Lack of effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg. 2011;113(5):994-1002.

Kanchi M. Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective. Ann Card Anaesth. 2011;14(1):25-9.

Xu F, Wang Q, Zhang H, Chen S, Ao H. Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes. PLoS One. 2015;10(2):e0117610.

Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294(13):1625-33.

Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, 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(9484):472-7.

Swan H, 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. New England Journal of Medicine. 1970;283(9):447-51.

Robin ED. Death by pulmonary artery flow-directed catheter. Time for a moratorium? CHEST Journal. 1987;92(4):727-31.

Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. New England Journal of Medicine. 2003;348(1):5-14.

Judge O, Ji F, Fleming N, Liu H. Current use of the pulmonary artery catheter in cardiac surgery: a survey study. J Cardiothorac Vasc Anesth. 2015;29(1):69-75.

Patel MR, Bailey SR, Bonow RO, Chambers CE, Chan PS, Dehmer GJ, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;59(22):1995-2027.

Gidwani UK, Goel S. The Pulmonary Artery Catheter in 2015: The Swan and the Phoenix. Cardiol Rev. 2016;24(1):1-13.

Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, Seamon MJ, Rodriguez Funes V, et al. Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg. 2009;98(4):199-208.

Siddiqui S, Das G, Ahmed S, Ghafoor H. Efficiency of PA catheters in the ICU of a tertiary care hospital. J Pak Med Assoc. 2006;56(8):375-7.

Meersch M, Schmidt C, Zarbock A. Echophysiology: the transesophageal echo probe as a noninvasive Swan-Ganz catheter. Curr Opin Anaesthesiol. 2016;29(1):36-45.1. Hensley FA, Martin DE, Gravlee GP. A practical approach to cardiac anesthesia. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013.

Daniels JP, Ansermino JM. Introduction of new monitors into clinical anesthesia. Curr Opin Anaesthesiol 2009;22(6):775–81.

Practice guidelines for pulmonary artery catheterization: an updated report by the American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization. Anesthesiology 2003;99(4):988–1014.

Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 2011;112(6):1392–402.

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev 2013;28(2):CD003408.

Schwann NM, Hillel Z, Hoeft A, Barash P, Mohnle P, Miao Y, et al. Lack of effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg 2011;113(5):994–1002.

Kanchi M. Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective. Ann Card Anaesth 2011;14(1):25–9.

Xu F, Wang Q, Zhang H, Chen S, Ao H. Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes. PLoS One 2015;10(2):e0117610.

Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 2005;294(13):1625–33.

Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, 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(9484):472–7.

Swan H, 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(9):447–51.

Robin ED. Death by pulmonary artery flow-directed catheter. Time for a moratorium? Chest 1987;92(4):727–31.

Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003;348(1):5–14.

Judge O, Ji F, Fleming N, Liu H. Current use of the pulmonary artery catheter in cardiac surgery: a survey study. J Cardiothorac Vasc Anesth 2015;29(1):69–75.

Patel MR, Bailey SR, Bonow RO, Chambers CE, Chan PS, Dehmer GJ, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;59(22):1995–2027.

Gidwani UK, Goel S. The Pulmonary Artery Catheter in 2015: The Swan and the Phoenix. Cardiol Rev 2016;24(1):1–13.

Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, Seamon MJ, Rodriguez Funes V, et al. Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg 2009;98(4):199–208.

Siddiqui S, Das G, Ahmed S, Ghafoor H. Efficiency of PA catheters in the ICU of a tertiary care hospital. J Pak Med Assoc 2006;56(8):375–7.

Meersch M, Schmidt C, Zarbock A. Echophysiology: the transesophageal echo probe as a noninvasive Swan-Ganz catheter. Curr Opin Anaesthesiol 2016;29(1):36–45.

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Published

2016-12-01