Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies

To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence. MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one. Six observational studies including 1,166,762 patients were selected. The most frequent etiology of CS was post-myocardial infarction (75% [95% CI 55–89%] in PAC-group and 81%[95% CI 47–95%] in non-PAC group). Overall, PAC was used in 33%(95% CI 24–44%) of cases. Pooling data adjusted for confounders, a significant association between the PAC-group and a reduction in short-term mortality emerged when compared to the non-PAC group (36%[95% CI 27–45%] vs 47%[95% CI 35–59%];AdjustedOR 0.71, 95% CI 0.59–0.87, p < 0.01). MCS use was significantly higher in PAC vs non-PAC group (59% [95% CI 54–65%]) vs 48% [95% CI 43–53%]);OR 1.60 [95% CI 1.27–2.02, p < 0.01]). PAC was associated with lower incidence of short-term mortality in CS pooling adjusted observational studies. Prospective studies are needed to confirm our hypothesis and better clarify the mechanisms of this potential prognostic benefit.