Consensus statement calls for study of PACs

United response to JAMA article

After the Journal of the American Medical Association published a controversial study on the effectiveness of pulmonary artery catheters (PACs) and called for a moratorium on their use, several critical care societies stepped into the fray.

A conference was convened in December 1996 by the Society for Critical Care Medicine, and last July, an unprecedented consensus statement was published on the use of PACs. Participants included the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the European Society of Intensive Care Medicine.

Summary of group’s findings

• No basis exists for a Food and Drug Administration moratorium on the use of PACs in the treatment of critically ill patients.

• Clinicians should continue to carefully weigh the benefits and risks of the PAC. Patients and their surrogates should be fully informed prior to the use of a PAC.

• Criteria for the appropriate use of the PAC in specific clinical situations should be developed.

• Clinician knowledge about the use of the PAC and its possible complications should be improved.

• Current training, credentialing, and continuing quality improvement issues related to the PAC should be re-evaluated.

• The indications and contraindications for PAC use where clinical equipoise is lacking should be determined.

• Clinical trials for indications where clinical equipoise exists should be performed.

• Financial support for the above projects should be obtained from funding agencies and industry leadership in the area of critical care medicine.