PAC offers no benefit for patients, according to new research
News release from the National Coordinating Centre for Health Technology Assessment
26 September 2006
New research funded by the HTA programme suggests that using bedside pulmonary artery catheterisation (PAC) in the management of critically ill patients provides no demonstrable benefit for patients. Researchers found no evidence that PAC, which has been the standard of care for people in intensive care units (ICUs) for nearly 30 years, enable patients to recover faster or improve survival.
An initial review of the existing evidence, led by Dr Kathy Rowan of the Intensive Care National Audit & Research Centre, identified little evidence to support the management of critically ill patients with PAC. A large, US, retrospective database study conducted in 1996 suggested that patients had increased likelihood of dying within 30 days of admission to an ICU if PAC was used, and that the procedure increased the overall costs of care.
Using evidence obtained from the systematic review, Dr Rowan’s team conducted a randomised controlled trial (RCT) involving more than 1,000 patients across 65 UK ICUs, the largest trial to date and first academic funded RCT in UK intensive care. They investigated patient survival rates and length of stay in the ICU, as well as conducting an economic evaluation.
The researchers found that using PAC to help manage critically ill patients neither improved hospital survival nor reduced the length of stay for adult, general intensive care patients and, in some cases, complications were associated with the insertion of a PAC.
“PAC was adopted into mainstream intensive care practice without any evaluation of its clinical or cost effectiveness, and indeed, recent research evidence suggested that the device may do more harm than good, so our research was essential” says Dr Kathy Rowan. “Our review found little evidence to support the use of PAC and our own trial found a lack of demonstrable benefit for patients. The use of PAC is declining with the introduction of newer, less invasive methods but these new devices should also be subjected to proper evaluation.”
The clinical trial has been published in the internationally acclaimed Health Technology Assessment Journal Vol 10.29. To download a copy visit http://www.hta.ac.uk/project.asp?PjtId=1120
Notes for editors
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The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
- The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
Contact details
Naomi Stockley, Programme Manager (Communications)
Telephone: 02380 595 646, Email: ns5@soton.ac.uk
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Telephone: 02380 595 584, Email: h.nikandrou@soton.ac.uk
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