In 2003, the CICM candidates were asked to "Compare and contrast the roles of the pulmonary artery catheter and transoesophageal echocardiography in the management of the critically ill patient with shock." This question has never appeared again, perhaps because the majority (91%) of the candidates were able to pass this question. The answer to that SAQ (Question 5 from the second paper of 2003) is presented below with little modification.
|
Issues |
PA catheter |
TOE |
|
cost |
Cheap |
Expensive |
|
Skill required |
Minimal expertise |
Skilled operator required |
|
Accuracy of measurements |
Positional; dependent on placement of balloon in Wests Zone 3. |
Operator-dependent |
|
Validity of interpretation |
Dependent on the normality of cardiac anatomy (accuracy diminishes in presence of valvular regurgitation or septal defects) |
Interpreter-dependent |
|
Information derived |
Pressure in chambers and in the PA. |
Anatomical information regarding cardiac structure Realtime observation of cardiac function |
|
Risks |
Haemorrhage/vascular access risks |
Oesophageal perforation |
|
Advantages |
Continuous monitoring technique Able to acquire blood samples |
Minimally invasive |
|
Disadvantages |
Invasive; significant risks of insertion |
Intermittent monitoring technique No sampling possible |
This is an article on how one might measure PAC-style chamber pressures using the TOE and the Bernoulli equation.
Chassot, P. G. "[Hemodynamic surveillance: transesophageal echocardiography or Swan-Ganz catheter?]." Revue medicale de la Suisse romande 121.9 (2001): 667-675.