Pulmonary artery catheters in acute heart failure: end of an era?

Whereas the pulmonary artery catheter (PAC) is still widely used in guiding assessment and treatment of heart failure, controversy surrounding its safety and efficacy has prompted development of newer, less invasive techniques. For these purposes, the transpulmonary thermodilution technique allows assessment of preload, cardiac output, filling volumes, and metrics of contractility without the need to pass a catheter through the right heart. In a previous issue of Critical Care, Ritter and colleagues compare metrics of transpulmonary thermodilution with the PAC in patients with acute heart failure and severe sepsis. The results add to a growing body of evidence that the PAC adds little to information attainable by less invasive methods in many conditions, including acute heart failure. Whether newer devices improve outcome needs to be tested in well-controlled prospective trials.