title: Trends in the use of pulmonary artery catheterization in the aneurysmal subarachnoid hemorrhage population.
abstract: Use of the pulmonary artery catheter (PAC) has been controversial since the late 1980s. Multi-center observational and randomized controlled trials (RCTs) have concluded that PACs fail to decrease mortality. Subsequently, studies have looked for a decline in PAC use that corresponds to the literature and have indeed found that it exists. However, none to date have looked primarily at trends in the aneurysmal subarachnoid hemorrhage (aSAH) population. This study uses the Nationwide Inpatient Sample (NIS) from 2000-2010 to identify trends in PAC use among patients with aSAH. Trend analysis was assessed using a multivariable regression model with a calculation of slope of PAC frequency over time for pre-2005 and post-2005. Trends in mortality and routine discharge were also assessed for the same time period. 363,096 SAH patients were extrapolated using survey weights, of whom 6,988 had a PAC. Over time, PAC use declined, with a significant downward shift in the year 2005. Analyses also showed a decrease in mortality over the same time period. Our results show that PAC use among patients with aSAH decreased from 2000 to 2010. Similar to other studies, the decline appears to be temporally related to RCTs that showed a lack of benefit from PAC. Studies such as these have the potential to influence clinical practice through illumination of shifting opinions and approaches.
authors.affiliation: Keck School of Medicine of the University of Southern California, 1795 Zonal Avenue, Los Angeles, CA 90033, USA. Electronic address: slinouye@usc.edu.
authors.forename: S
authors.initials: S
authors.lastname: Inouye
authors.affiliation: Keck School of Medicine of the University of Southern California, 1795 Zonal Avenue, Los Angeles, CA 90033, USA.
authors.forename: D
authors.initials: D
authors.lastname: Jin
authors.affiliation: Keck Hospital of the University of Southern California, Department of Radiology, Los Angeles, CA 90033, USA; Keck Hospital of the University of Southern California, Department of Neurology, Los Angeles, CA 90033, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cen
authors.affiliation: Keck Hospital of the University of Southern California, Department of Neurology, Los Angeles, CA 90033, USA.
authors.forename: P
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Keck Hospital of the University of Southern California, Department of Neurology, Los Angeles, CA 90033, USA.
authors.forename: N
authors.initials: N
authors.lastname: Renda
authors.affiliation: Keck Hospital of the University of Southern California, Department of Neurosurgery, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Amar
authors.affiliation: Keck Hospital of the University of Southern California, Department of Neurosurgery, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Keck Hospital of the University of Southern California, Department of Neurology, Los Angeles, CA 90033, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Kim-Tenser
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications; D002407:Catheterization, Swan-Ganz / Q000639:trends*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*
keywords: Aneurysmal subarachnoid hemorrhage; Neurocritical care; Pulmonary artery catheter; Swan–Ganz catheter