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eComment: Double-knotted Swan-Ganz catheter – potential for non-invasive ultrasonic cardiac output monitoring?

Plastic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany

Intraoperative removal of a knotted Swan-Ganz catheter during lung transplantation

I read with great interest the recent report by Dr. Camargo [1]. Complicationsusing an invasive Swan-Ganz catheter have been encountered sincethe introduction of the catheter [2]. As early as in 1976 Dr. Block reportedthe snaring of a Swan-Ganz catheter by a suture to control bleeding in theright atrium [3]. We encountered a double-knotted Swan-Ganz catheter in apatient following coronary artery bypass grafting with fatal outcome due topump failure. Therefore, no attempt was performed to retrieve the doubleknottedSwan-Ganz catheter percutaneously.

Given the potential fatal complications of invasive Swan-Ganz catheters,non-invasive means of cardiac output monitoring might be considerable.Ultrasonic cardiac output monitoring (USCOM, Sydney, Australia) using CWDopplerhas been reported to correlate highly with invasive Swan-Ganzcatheter cardiac output in postcardiac surgery patients with a mean differenceof 0.2 l/min and a correlation coefficient r=0.870 [4]. A recentcomparative study between USCOM and Swan-Ganz catheters in instable ICUpatients found acceptable correlations [5].

Thus, in a selected patient cohort, given the potential complications ofinvasive Swan-Ganz cardiac output monitoring, it might be worth consideringnon-invasive alternatives for hemodynamic assessement.

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1. Camargo JD, Camargo SM, Machuca TN, Wagner P. Intraoperative removal of a knotted Swan-Ganz catheter during lung transplantation. Interact CardioVasc Thorac Surg 2008;7:861–863.[Abstract/Free Full Text]
2. Daum S, Schapira M. Intracardiac knot formation in a Swan-Ganz catheter. Anesth Analg 1973;52:862–863.[Free Full Text]
3. Block PC. Snaring of a Swan-Ganz catheter. J Thorac Cardiovasc Surg 1976;71:917–919.[Abstract]
4. Knobloch K, Lichtenberg A, Winterhalter M, Rossner D, Pichlmaier M, Phillips R. Non-invasive cardiac output determination by two-dimensional independent Doppler during and after cardiac surgery. Ann Thorac Surg 2005;80:1479–1483.[Abstract/Free Full Text]
5. van Lelyveld-Haas LE, van Zanten AR, Borm GF, Tjan DH. Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients. Eur J Anaesthesiol 2008;24:1–8.[Medline]

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