Systemic coagulation changes caused by pulmonary artery catheters: Laboratory findings and clinical correlation

David R. King, Stephen M. Cohn, Ara J. Feinstein, Kenneth G. Proctor*, Michael Shapiro, Martin A. Schreiber, Jeffrey H. Levine, Faran Bokhari, Kimberly Nagy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG). Methods: Animal: Healthy, anesthetized, swine (n = 19) underwent PA catheterization. Samples were drawn from TF femoral arterial catheters before and two hours after PA catheterization, at 5 mL/ min, and analyzed (native whole blood, n = 15, kaolin activated blood, n = 4) by TEG (Hemoscope, Niles, IL) at precisely two minutes. Human: An IRB-approved prospective, observational trial was conducted in critically ill patients (n = 19). Samples were drawn from 22-gauge radial artery catheters, before and three hours after PA catheterization. Kaolin-activated TEG samples were analyzed at precisely five minutes. Data are mean ± SE; Groups were compared with analysis of variance and significance was assessed at the 95% confidence interval. Results: In both animals and patients, PA catheterization truncated R times (time to initial fibrin formation). In swine, the R times were 17.6 ± 1.3 minutes (native) and 3.8 ± 04 (kaolin) before PA catheterization, and decreased to 6.3 ± 1.0 minutes (p = 0.002) and 1.9 ± 0.5 minutes (p = 0.010) afterward. There were no changes in pH or temperature during the experiment. In patients, 4 of 19 were excluded for protocol violations. The R time was 6.3 ± 1.0 minutes (kaolin) before and 3.0 ± 0.3 minutes after catheterization (p = 0.003). No changes were observed in conventional coagulation parameters, temperature or pH. Conclusion: In healthy swine, and critically ill patients, PA catheters may enhance thrombin formation and fibrin polymerization, indicating a systemic hypercoagulable state. This may explain why PA catheters are associated with an increased risk of pulmonary emboli.

Original languageEnglish (US)
Pages (from-to)853-859
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number4
DOIs
StatePublished - Oct 2005

Keywords

  • Coagulation
  • Pulmonary Artery Catheter
  • Pulmonary Embolism
  • Swine
  • Thromboelastography

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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