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Pulmonary artery catheters or central venous catheters for cardiac surgery: the PUMA Pilot randomised clinical trial.

Luke A Perry·Reny Segal·Marco Larobina·Rinaldo Bellomo·Julian A Smith·Jesselyn Sin·Katrina Danial·Alistair R D McLean·Lisa Q Rong·Mario Gaudino·Thomas Schwann·Marie Palumbo·Luke O'Halloran·Brian Chee·Jinesh Patel·Andrew Silvers·Jayme Bennetts·Silvana Marasco·Tim G Coulson·Alistair Royse·Emily See·Lachlan F Miles·ANZCA Clinical Trials Network
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Abstract

INTRODUCTION: Pulmonary artery catheters are used widely in cardiac surgery despite observed associations with worse outcomes and guidelines that recommend against their routine use. No adequately powered randomised trials are available. METHODS: The PUMA Pilot was a multicentre, randomised, parallel assignment, open-label, pilot and feasibility trial conducted at three tertiary cardiac surgery centres. Eligible patients were adults undergoing coronary artery bypass grafting, aortic valve replacement or surgery on the aortic root or ascending aorta with or without aortic valve replacement, with a predicted surgical mortality of <&#x2009;2%. Patients were allocated randomly to receive a pulmonary artery catheter or a central venous catheter inserted immediately before surgery. The primary feasibility outcome was protocol compliance, defined as receiving the assigned intervention without crossover. Secondary feasibility outcomes were eligibility rate; recruitment proportion and rate; data completeness; and rate of clinician refusal. RESULTS: We screened 480 patients and 206 (43%) were eligible; 150/203 (74%) approached provided informed consent. Three of 206 (1%) eligible patients were not included due to clinician refusal. Of 149 patients who were randomised, 76 were assigned to the pulmonary artery catheter group and 73 to the central venous catheter group. For the primary feasibility outcome, 147 patients (99%) received the allocated intervention. Data were complete for 144 (97%) patients. Median (IQR [range]) days alive and at home at 30&#x2009;days was 23.7 (21.9-24.7 [7.0-26.0]) in the pulmonary artery catheter group and 22.9 (20.8-23.9 [8.6-25.8]) in the central venous catheter group. Acute kidney injury occurred in 26/76 (34%) patients in the pulmonary artery catheter group and 14/73 (19%) in the central venous catheter group. DISCUSSION: A randomised trial of pulmonary artery catheters compared with central venous catheters in low-risk cardiac surgery is feasible. Such a trial would address significant practice variability and inform international guidelines.

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HumansPilot ProjectsFemaleAgedMaleCardiac Surgical ProceduresFeasibility StudiesCatheterization, Swan-GanzMiddle AgedCentral Venous CathetersCatheterization, Central Venouscardiac anaesthesiacardiac surgeryfeasibility studieshaemodynamic monitoringpulmonary artery catheterJournal ArticleRandomized Controlled TrialMulticenter Study

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Luke A Perry, Reny Segal, Marco Larobina, Rinaldo Bellomo, Julian A Smith, Jesselyn Sin, Katrina Danial, Alistair R D McLean, Lisa Q Rong, Mario Gaudino, Thomas Schwann, Marie Palumbo, Luke O'Halloran, Brian Chee, Jinesh Patel, Andrew Silvers, Jayme Bennetts, Silvana Marasco, Tim G Coulson, Alistair Royse, Emily See, Lachlan F Miles, ANZCA Clinical Trials Network. 2026-06-28. Pulmonary artery catheters or central venous catheters for cardiac surgery: the PUMA Pilot randomised clinical trial.. https://doi.org/10.1111/anae.70282

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