The PUMA Pilot will establish the feasibility of conducting a large, multicentre, and definitive randomised trial of pulmonary artery catheter use in low-risk cardiac surgery (PUMA II). This world-first trial will address a hotly debated and highly editorialised topic in cardiac anaesthesia and could lead to a shift away from an area of potentially low-value care.
While pulmonary artery catheters can provide unique data on cardiovascular physiology that can be used to guide therapeutic decision-making in the perioperative period, they may also have unintended consequences. Some studies have suggested that their use could trigger more intense and potentially unnecessary therapies, leading to increased rates of complications and longer stays in the intensive care unit by up to 35%. Despite this, their use remains pervasive with particular uncertainty regarding their role in low-risk cases.
Pulmonary artery catheters have never been rigorously evaluated in a randomised controlled trial, and clinical practice guidelines have relied on low-quality evidence. Accordingly, there is an urgent and unmet need to define the possible risks and benefits of this frequently used monitoring device.
The PUMA Pilot is an interdisciplinary collaboration involving cardiac anaesthetists, surgeons, intensivists, statisticians, health economists, and consumers. It will be conducted across two sites in 2023 and will enrol adults undergoing low risk coronary artery bypass or aortic valve replacement surgery.
Dr Luke Perry, Royal Melbourne Hospital
Professor Rinaldo Bellomo, Austin Hospital, Melbourne
Professor Julian Smith, Monash Medical Centre, Melbourne
Professor Alistair Royse, Royal Melbourne Hospital
Professor Reny Segal, Royal Melbourne Hospital
Dr Marco Larobina, Royal Melbourne Hospital
Dr Luke O'Halloran, Monash Medical Centre, Melbourne
Dr Alistair McLean, University of Melbourne.
The project was awarded $A69,981 funding through the ANZCA research grants program for 2023.