Distal Migration of the Pulmonary Artery Catheter During Cardiac Surgery With Cardiopulmonary Bypass Observed Using Transesophageal Echocardiography: A Prospective Observational Study.

OBJECTIVES

To investigate the extent of pulmonary artery catheter (PAC) tip migration during cardiac surgery using cardiopulmonary bypass (CPB), as visualized by transesophageal echocardiography (TEE).

DESIGN

A prospective, observational study.

SETTING

A single tertiary university hospital operating room.

PARTICIPANTS

A total of 146 adult patients undergoing elective cardiac surgery with cardiac arrest and CPB who received PAC placement.

INTERVENTIONS: PACs were inserted under TEE guidance, positioning the tip at the 1 o'clock position in the proximal right pulmonary artery. TEE was used throughout surgery to monitor PAC tip position, particularly before and after CPB.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the distance of PAC tip migration during surgery. The median migration distance from pre to post CPB was 3.0 cm (interquartile range, 3.0-4.0 cm), prompting catheter withdrawal in these cases. Patients requiring >3 cm withdrawal had significantly longer catheter insertion lengths and higher mean pulmonary artery pressure and central venous pressure before CPB. Identified cutoff values were 46.5 cm for catheter length, 22.5 mmHg for mean pulmonary artery pressure, and 9.5 mmHg for central venous pressure.

CONCLUSIONS

TEE-enabled direct visualization showed that PAC tips commonly migrate approximately 3 cm during cardiac surgery with CPB, necessitating withdrawal to prevent distal complications. Patients with longer catheter insertions and higher pulmonary artery pressure and central venous pressure may require more extensive withdrawal. TEE monitoring is a valuable tool for guiding PAC management during cardiac surgery.