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Widely Used Surgical Device Doesn't Benefit Older Patients

Pulmonary artery catheter no help to high-risk patients

THURSDAY, Jan. 2, 2003 (HealthDayNews) -- The pulmonary artery catheters that are implanted in more than a million surgical patients in the United States every year do no good -- but also no harm -- in older, high-risk patients, a Canadian study finds.

It's too early to tell whether the results can be generalized to cover all surgical patients, says Dr. James Dean Sandham, a professor in the University of Calgary's department of critical care, and the lead author of a paper reporting the results in today's New England Journal of Medicine.

But the study shows that "routine use of the catheter in this group of patients found no evidence of value," he says.

Almost equally important, the study found no evidence that the catheter increased the death rate of surgical patients, Sandham adds. The patients underwent major abdominal, thoracic, vascular or hip-fracture surgery.

There have been doubts about this catheter's use since a 1996 report found a higher death rate among patients who had one implanted during surgery. Although this latest study found "small but definite risk of increased pulmonary embolism" in patients who got the catheter compared to those who did not, "the death rate in both groups was similar," Sandham says.

A pulmonary artery catheter is a balloon-tipped tube that is placed in that blood vessel to obtain measurements that can help refine treatment. It now is used in more than 1.2 million patients in the United States every year, at an estimated cost of more than $2 billion.

"A layperson might assume that if a form of medical technology is so widely used, there must be clear-cut indications for its clinical use," says an accompanying editorial by Dr. Polly E. Parsons of the University of Vermont. "Unfortunately, that would be an incorrect assumption."

Despite the alarm about possible ill effects of the catheter arising from the 1996 study, "some surgeons feel that it is not ethical to practice without using the catheter," Sandham says. "We show that it is ethical not to use it in this group of patients."

The 1,994 patients in the study were all 60 or older and had medical conditions that required them to be put in an intensive care unit after surgery. The in-hospital death rate was virtually the same for those who got the catheter (7.8 percent) and those who did not (7.7 percent). The six-month survival rate was also virtually identical for both groups: 87.4 percent for patients who got catheters, 88.1 percent for those who did not.

The only significant difference was that eight of the catheter patients had pulmonary embolisms, while none of the no-catheter patients did.

The study results "can be generalized only to patients similar to those we studied, who are age 60 or more, having major surgery on an elective or urgent basis, and whose associated medical conditions make them high-risk," Sandham says. And the results "open the door for studies in a wider group of patients," such as those who are younger and have severe trauma or shock.

At least one study looking at a broader group of patients is under way, he adds.

What To Do

You can learn more about pulmonary artery catheters from Cardiac Consultants or from this exchange in the Journal of the American Medical Association.

SOURCES: James Dean Sandham, M.D., professor, department of critical care medicine, University of Calgary, Canada; Jan. 2, 2003, New England Journal of Medicine
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