Swan song for the Swan-Ganz catheter?

An American study published earlier this month has shown that the use of a pulmonary artery catheter is associated with increased mortality in a wide range of conditions, including many of the accepted indications for using a catheter.1 Is this finding unexpected—and what should we do about it? Connors et al retrospectively reviewed 5735 critically ill patients with one of nine prespecified disease categories treated in 1989-94. They assessed the severity of illness in all patients and compared the outcome in those who received and those who did not receive a pulmonary artery catheter within the first 24 hours of care. The patients receiving a pulmonary artery catheter had higher APACHE III scores and lower predicted survival at two months. They also had higher mortality, length of stay, and financial costs. To compare with those who did not receive a pulmonary artery catheter, propensity scores (a new statistical method) were used to adjust for treatment selection. The results strongly suggest that in all groups mortality, the length of intensive care, and hospital costs were higher when a pulmonary catheter was used. Catheters seemed to have the highest associated risk in postoperative patients and those who were not severely ill. …