![]() ![]() ![]() This phenomenon occurred despite that fact that the safety, accuracy, and benefit of the device had never been established.Įugene Robin was the first clinician to challenge the widespread adoption of the PAC. In the 1980s 20% to 40% of seriously ill patients who were hospitalized were reported to undergo pulmonary artery catheterization. Indeed, the PAC became the cornerstone of critical care and a hallmark of the ICU. After the introduction of the PAC, enthusiasm for the device increased and its use increased exponentially. Clinicians began to use the hemodynamic data derived from the PAC to select, modify and monitor medical treatments. The use of the PAC moved from the cardiac catheterization laboratory to the ICU and operating room and its use changed from being used as a diagnostic to a therapeutic tool. in 1970, the balloon tipped PA catheter became commercially available and it began to be used in a variety of clinical settings. Shortly after the publication by Swan et al. The PAC was subsequently modified with a thermistor to allow measurement of cardiac output (CO). After observing a spinnaker on a sailboat off Santa Monica beach, the idea of a flow-directed PA catheter (PAC) was developed by Swan and Ganz in 1970, allowing bedside placement. Pulmonary artery (PA) catheterization was first performed by Lewis Dexter in 1945. This paper reviews the rise and fall of the conventional PAC. His cousin (the continuous cardiac output PAC) continues to eke a living mostly in cardiac surgery patients who need central access anyway. While a handful of die-hard followers continued to promote his mission, the last few years of his existence were spent as a castaway until his death in 2013. To make matter worse, dynamic assessment of fluid responsiveness (pulse pressure variation, stroke volume variation and leg raising) made a mockery of his ‘wedge’ pressure. Pretty soon after that, a posse of rivals (bedside echocardiography, pulse contour technology) moved into the neighborhood and claimed they could assess cardiac output more easily, less invasively and no less reliably. It also became clear that he was poorly understood and misinterpreted. Furthermore, reports surfaced suggesting that he was unreliable and inaccurate. This was followed by randomized controlled trials demonstrating he was of little use. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. ![]()
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