• Laurence Weinberg, Lachlan F Miles, Maysana Allaf, Param Pillai, Philip Peyton, and Laurie Doolan.
• Department of Anesthesia, Department of Surgery and Centre for Anesthesia, Perioperative and Pain Medicine, The University of Melbourne, Victoria, Australia. Electronic address: laurence.weinberg@austin.org.au.
• J. Cardiothorac. Vasc. Anesth. 2015 Dec 1; 29 (6): 1511-6.

ObjectivesTo determine whether video fluoroscopy combined with traditional pressure waveform analyses facilitates optimal pulmonary artery catheter (PAC) flotation and final positioning compared with the traditional pressure waveform flotation technique alone.DesignProspective, single-center, randomized, controlled trial.SettingSingle-center university teaching hospital.ParticipantsThe study included 50 cardiac surgery patients at higher risk for PAC complications.InterventionsUse of video fluoroscopy to facilitate optimal PAC flotation and positioning.Measurements And Main ResultsThe primary outcome was the time taken to float and position the PAC balloon in the pulmonary artery as confirmed by transesophageal echocardiography. Secondary outcomes included number of attempts at flotation, ventricular rhythm disturbances, and catheter malposition. Patients were evenly matched in baseline demographics, New York Heart Association symptoms of heart failure, severity of left and right ventricular dysfunction, end-diastolic pressures and dimensions, severity of tricuspid valvular disease, and atrial and pulmonary artery pressures. Mean (SD) time to float the PAC was significantly shorter in the video fluoroscopy group than in the usual care group: 73 seconds (SD, 65.1) versus 176 seconds (SD, 180.6), respectively; p = 0.014. The median (interquartile range [IQR]) number of attempts to successful flotation was fewer in the video fluoroscopy group than in the usual care group: 1 (IQR 1:2) attempt versus 2 (IQR 1:4) attempts, respectively; p = 0.007. The composite complication rate (malposition and arrhythmias) was lower in the video fluoroscopy group than in the usual care group (16% v 52%, respectively; p = 0.01).ConclusionsIn cardiac surgery patients at higher risk for PAC complications, video fluoroscopy facilitated faster and safer catheter flotation and positioning compared with the traditional pressure waveform flotation technique.Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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