Efficacy concerns PA catheter and tailored therapy

Efficacy concerns (NEJM 2006;354:2213; JAMA 2005;294:1664)

• No benefit to routine PAC use in high-risk surgery (JACC 2014;62:e77), sepsis, ARDS

• No benefit in decompensated HF (JAMA 2005;294:1625); untested in cardiogenic shock

• But: ~½ of clinical CO & PCWP estimates incorrect; CVP & PCWP not well correl.; ∴ use PAC to (a) answer hemodynamic ? and then remove, or (b) manage cardiogenic shock