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The PAPIKAS trial: a comparative clinical trial of pulmonary catheter versus the PiCCO device during therapy of patients with acute heart failure and cardiogenic shock

Introduction

Haemodynamic measurement plays an important role in the treatment of patients with acute heart failure and cardiogenic shock (CS). The pulmonary catheter (PAC) is a common device for enhanced haemodynamic measurement. The aim of this study was to evaluate the comparability of the PiCCO device with the PAC during the treatment of patients with CS; for example, the use of intra-aortic counterpulsion (intraaortic balloon pumping (IABP)), and therapeutic hypothermia after cardiac arrest.

Methods

Seventy-seven measurements were taken in 11 critically ill patients during the therapy of cardiogenic shock. The cardiac index (CI), stroke volume (SVI), and systemic vascular resistance (SVRI) were measured by pulmonary catheter and PiCCO device, as well as the pulmonary aortic occlusion pressure (PAWP) with a pulmonary catheter and the global end-diastolic volume (GEDI) with the PiCCO device, and registered in a commercially available computer system.

Results

A good correlation between the two techniques in all data, as well as during the use of IABP or during hypothermia was shown. The mean bias between CIpa and CIart was 0.042. The calculated mean error was 24.89%, 26.17% and 19.08%, respectively. There was also a good convergence between the measurements of vascular resistance in overall data and during IABP. Significant correlations were found for SVIpa, SVIpi, SVRIpa, SVRIpi to CIpa. For GEDI there was a significant correlation with CIpa for data collected during cooling. No significant correlation between PAWP und CIpa was found.

Conclusions

The data show interchangeability for the two methods using intermitting measurements during therapy of cardiogenic shock even during intra-aortic counterpulsation and therapeutic hypothermia. The cardiac output seems to be related to the GEDI as a preload parameter; no relationship between PAOP and CI can be shown. The usability of the less invasive PiCCO device for the enhanced hemodynamic measurement in patients with acute heart failure and cardiogenic shock is ensured.

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Correspondence to T Schwab.

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Schwab, T., Schmid, B., Richter, S. et al. The PAPIKAS trial: a comparative clinical trial of pulmonary catheter versus the PiCCO device during therapy of patients with acute heart failure and cardiogenic shock. Crit Care 14, P98 (2010). https://doi.org/10.1186/cc8330

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Keywords

  • Vascular Resistance
  • Cardiac Index
  • Cardiogenic Shock
  • Systemic Vascular Resistance
  • Acute Heart Failure