PAC-Man
Trial question
What is the role of pulmonary artery catheters in the management of critically ill patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 1014
1014 patients (423 female, 591 male).
Inclusion criteria: adult patients admitted to an ICU.
Key exclusion criteria: age < 16 years; elective admission for preoperative optimization; presence of a pulmonary artery catheter on admission to intensive care; previous enrollment to the study; or hemodynamic optimization before organ donation.
Interventions
N=519 pulmonary artery catheter (catheter placed as soon as possible after randomization, according to local practice).
N=522 control (management without pulmonary artery catheter).
Primary outcome
Death in hospital
68%
66%
68.0 %
51.0 %
34.0 %
17.0 %
0.0 %
Pulmonary artery
catheter
Control
No significant
difference ↔
No significant difference in death in the hospital (68% vs. 66%; HR 1.07, 95% CI 0.92 to 1.24).
Secondary outcomes
Borderline significant increase in median organ-days of support in the ICU among survivors (19 days vs. 19 days).
No significant difference in median ICU length of stay among survivors (12.1 days vs. 11 days; AD 1.1 days, 95% CI -0.8 to 3).
No significant difference in median hospital length of stay among survivors (34 days vs. 40 days; AD -6 days, 95% CI -20.65 to 8.65).
Safety outcomes
No significant differences in death at 28 days, death in the ICU.
Conclusion
In adult patients admitted to an ICU, pulmonary artery catheter was not superior to control with respect to death in the hospital.
Reference
Sheila Harvey, David A Harrison, Mervyn Singer 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 Aug 6-12;366(9484):472-7.
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