Pulmonary artery rupture associated with the Swan-Ganz catheter.

OBJECTIVES

This study was designed to determine the incidence rate, define risk factors, and suggest proper management protocols for pulmonary artery (PA) rupture associated with Swan-Ganz catheters.

DESIGN

This is a retrospective chart-review study.

SETTING

This study involved 32,442 inpatients requiring hemodynamic monitoring with Swan-Ganz catheters in the operating rooms and ICUs at a large, private teaching hospital over a 17-year period (1975 to 1991).

RESULTS

Ten patients sustained PA rupture, yielding an observed rupture rate of 0.031% of catheter insertions. All ten patients had hemoptysis and five (50%) had pulmonary hypertension. Two patients (20%) had undergone anticoagulation at the time of rupture. Four of the six surgical patients were still in surgery at the first sign of rupture. A thoracotomy was performed in five patients. We noted a trend toward survival with thoracotomy, but it was not statistically significant. The overall mortality rate was 70%. When data from our 10 patients were combined with 65 patients from the literature, we found that thoracotomy was essential for survival in patients with hemothorax. There were no survivors among seven patients with hemothorax simply observed, compared with eight (50%) survivors in 16 patients undergoing thoracotomy (p = 0.026). Thirty-nine (75%) of 52 patients without hemothorax survived, whether or not a thoracotomy was performed.

CONCLUSIONS

Our study suggested that the incidence of Swan-Ganz catheter-associated PA rupture is 0.031% and that an urgent thoracotomy should be performed if hemothorax is present at any point.