Pulmonary Artery Catheter Monitoring in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Intensive Care Medicine
• Clinical Research

Background:

• The role of pulmonary artery catheterization (PAC) in cardiogenic shock (CS) is debated, with conflicting evidence from prior trials and contemporary registries.
• Existing evidence is fragmented, lacking consistent reporting on patient phenotypes and outcomes.

Purpose of the Study:

• To assess the association between PAC use and clinical outcomes in adult patients with CS.
• To synthesize current evidence on PAC's impact on mortality, mechanical circulatory support (MCS), and sepsis in CS.

Main Methods:

• Systematic literature search of MEDLINE, Cochrane, and Scopus (2015-2025) for observational and registry studies in adult CS.
• Meta-analysis of pooled odds ratios (OR) and hazard ratios using random-effects models.
• Inclusion of outcomes such as in-hospital/30-day mortality, MCS initiation, and sepsis; performance of subgroup, meta-regression, and trial sequential analyses.

Main Results:

• PAC use was associated with significantly lower in-hospital/30-day mortality (OR 0.70) across CS phenotypes, despite heterogeneity.
• PAC use correlated with higher rates of MCS initiation (OR 2.76), with evidence of publication bias.
• PAC use was also linked to an increased risk of sepsis (OR 1.83).

Conclusions:

• Pulmonary artery catheterization (PAC) use is consistently associated with improved survival in cardiogenic shock (CS).
• Increased use of mechanical circulatory support (MCS) in conjunction with PAC is associated with a higher risk of sepsis.
• Findings support the systematic use of PAC as a therapeutic enabler in CS and should guide future clinical protocols and trial designs.