Francisco Chacón-Lozsán: Pulmonary Artery Catheter in Cardiogenic Shock From Obsolete Device to Modern Decision Tool
Francisco Chacón-Lozsán, Fellow at World Extreme Medicine, Member of European Society of Intensive Care Medicine (ESICM) and American College of Cardiology, shared a post on LinkedIn:
”Pulmonary artery catheter: dead… or misunderstood?
For years, we were told:
- ‘No mortality benefit’
- ‘Too invasive’
- Old technology’
But in cardiogenic shock… the story is changing.
New meta-analysis. Approximately 790,000 patients.
The signal is clear:
- Mortality decreased(OR 0.70)
- Hazard of death decreased by 32%
- Use of MCS increased(OR 2.76)
- Sepsis risk increased(OR 1.83)
So what’s really happening?
This is not about the catheter.
It’s about what you do with the data.
PAC as a ‘therapeutic enabler’
PAC doesn’t treat patients.
It enables:
- Phenotype-driven shock classification
- Precise preload / afterload optimization
- Early identification of RV failure
- Timely escalation to MCS
In other words:
It transforms guesswork into strategy
Why previous trials failed
Pacman. Escape.
They showed no benefit.
But the problem wasn’t the catheter…
It was the absence of:
- Structured protocols
- Shock teams
- Clear hemodynamic targets
Modern cardiogenic shock is different
Today we have:
- Shock teams
- SCAI staging
- Protocol-driven escalation
- Advanced MCS (Impella, ECMO)
In this context, PAC becomes powerful.
The trade-off
Let’s be honest:
- Increased infection risk
OR approximately 1.8 for sepsis
So:
- Use it selectively
- Use it early
- Remove it as soon as possible
Key takeaway
PAC is not obsolete.
It was misused.
And now, in the right hands:
It may be one of the most important tools in cardiogenic shock.”
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