Cardiology in critical care · Invasive haemodynamic monitoring
Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Therapy guided by pulmonary artery catheter plus clinical assessment |
| Control | Therapy guided by clinical assessment alone |
| Population | 433 patients hospitalised with severe symptomatic recurrent heart failure |
| Follow-up | 6 months |
| Primary endpoint | Days alive and out of hospital during the first 6 months |
| Result | The pulmonary artery catheter did not affect the primary endpoint of days alive and out of hospital over 6 months (133 versus 135 days; hazard ratio 1.00, 95% CI 0.82 to 1.21, p=0.99), mortality (43 of 433 [10%] versus 38 [9%]; odds ratio 1.26, 0.78 to 2.03, p=0.35) or days hospitalised (8.7 versus 8.3). Baseline illness was severe — mean ejection fraction 19%, systolic pressure 106 mmHg, creatinine 1.5 mg/dL. Both groups had substantial reductions in symptoms, jugular venous pressure and oedema. Anticipated adverse events were more frequent with the catheter. |
| Secondary endpoints | Mortality, hospitalisation, exercise capacity, quality of life, adverse events |
Therapy to reduce volume overload during hospitalization for heart failure led to marked improvement in signs and symptoms of elevated filling pressures with or without the PAC. Addition of the PAC to careful clinical assessment increased anticipated adverse events, but did not affect overall mortality and hospitalization.
The trial authors, in the published abstract
One of the trials that ended the routine pulmonary artery catheter. The framing matters: it does not show the catheter gives bad information, but that acting on clinical assessment achieves the same result without the risk. The same reasoning now applies to arterial lines (Deferred arterial catheter).
Binanay C, Califf RM, Hasselblad V, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 2005 Oct 5;294(13):1625-33.