Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 3 (1), 38

Obituary: Pulmonary Artery Catheter 1970 to 2013


Obituary: Pulmonary Artery Catheter 1970 to 2013

Paul E Marik. Ann Intensive Care.


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. 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. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. This was followed by randomized controlled trials demonstrating he was of little use. Furthermore, reports surfaced suggesting that he was unreliable and inaccurate. It also became clear that he was poorly understood and misinterpreted. 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. 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. 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. His cousin (the continuous cardiac output PAC) continues to eke a living mostly in cardiac surgery patients who need central access anyway. This paper reviews the rise and fall of the conventional PAC.

Similar articles

See all similar articles

Cited by 22 articles

See all "Cited by" articles


    1. Dexter L, Haynes FW, Burwell CS, Eppinger EC, Seibel RE, Evans JM. Studies of congenital heart disease, I: technique of venous catheterization as a diagnostic procedure. J Clin Invest. 1947;26:547–553. doi: 10.1172/JCI101839. - DOI - PMC - PubMed
    1. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283:447–451. doi: 10.1056/NEJM197008272830902. - DOI - PubMed
    1. Ganz W, Donosco R, Marcus HS, Forrester JS, Swan HJ. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol. 1971;27:392–396. doi: 10.1016/0002-9149(71)90436-X. - DOI - PubMed
    1. Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993 to 2004. JAMA. 2007;298:423–429. doi: 10.1001/jama.298.4.423. - DOI - PubMed
    1. Robin ED. Death by pulmonary artery flow directed catheter, time for a moratorium? Chest. 1987;92:727–731. doi: 10.1378/chest.92.4.727. - DOI - PubMed

LinkOut - more resources