RETROSPECTIVE RANDOMIZED STUDY OF USE OF PULMONARY ARTERY CATHETER IN CARDIAC SURGERY PATIENT IN HIGH VOLUME TERTIARY CENTER.

Background: Pulmonary artery catheter (PAC) is a diagnostic and haemodynamic monitoring tool. The PAC is used by clinicians in adult medical ICUs, cardiac catheterization laboratories and coronary care units (CCUs). Objective: To determine the indications for the use of pulmonary artery catheter (PAC) in patients undergoing cardiac surgery and to study the outcome of patients with PAC undergoing cardiac surgery. Methods: The present study was carried out in Department of Anesthesiology, Narayana Hrudayalaya, Bangalore. In our study 1000 patients with PAC were assessed retrospectively and data of patients was collected from 2017-2019. EuroSCORE of patients was calculated to assess preoperative condition of the patient prior to surgery. Results: Data of one thousand patients with PAC was collected. The following observations were seen. 71.5% patients were of age <60 years. 77.8% patients were males, and 22.8% patients were female. The most common indication for PAC insertion was PAH (pulmonary artery hypertension) (37.2%), followed by hemodynamic monitoring (33.2%), followed by heart failure with reduced ejection fraction (low EF) (24.3%), hypertrophic obstructive cardiomyopathy (HOCM) (3.1%), severe right ventricular (RV) dysfunction (1.0%), ventricular assist device (VAD) & cardiac transplant (0.8%), others (0.4%). During PAC insertion 0.5% patients developed transient cardiac arrhythmia, 0.2% patients had mild bleeding at insertion site. Postoperative data analysis showed that in patients with PAC post op 23.5% required IABP, 13.9% had cardiac arrest, death (12.9%), stroke (5%), septicemia (4.1%). Among patient with (EuroSCORE 1-3, n=188), (EuroSCORE 4-6, n=529), (EuroSCORE 7-10, n=212), (EuroSCORE >10, n=55); ICU stay was >10 days in 15.4%, 16.44%, 20.75%, 60% respectively with p<0.001. Hospital stay was 10 ±5days in 47.3 % cases, 23 ± 7days among 38.5% patients, 38 ± 7 among 14.8% patients, 53 ± 7days among 0.4% patients and 75 ± 14.5among 0.3% patients. Conclusion: PAC is an important tool to monitor continuous cardiac output, systemic vascular resistance, pulmonary artery pressure. Use of PAC has shown to guide appropriate vasopressor and ionodilator therapy. Our study showed 0.7 % complications during procedure which were reversible and could be managed conservatively. Patient with high EuroSCORE and severe cardiac dysfunction had higher mortality, and hence mortality cannot be directly attributed to PAC. [ABSTRACT FROM AUTHOR]