Binanay C et al. (2005) Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 295: 1625–1633

Use of a pulmonary artery catheter (PAC) for hemodynamic monitoring in patients with severe heart failure is controversial, partly because its effect on patients' outcomes is uncertain.

The Evaluation Study of Congestive Heart Failure and Pulmonary Catheterization Effectiveness (ESCAPE) trial was designed to establish whether therapy guided by PAC monitoring and clinical assessment improves outcomes, with fewer days spent in hospital over 6 months, compared with therapy guided by clinical assessment alone. This multicenter, randomized trial was sponsored by the National Heart, Lung, and Blood Institute, and enrolled 433 patients with severe symptomatic heart failure.

Although in-hospital adverse events occurred more frequently among patients who had received therapy guided by PAC, there was no overall increase in mortality, or the length of time spent in hospital. A consistent trend for improved cardiac function and exercise ability was observed in recipients of PAC-guided therapy, and the trial also found that patients with advanced heart failure frequently have a preference for increasing quality, rather than length of life.

In conclusion, there is no indication for routine use of PACs in patients admitted to hospital with heart failure, although this might be a useful approach for patients in whom initial therapy fails to relieve symptoms of clinical congestion.