Towards eliminating low-value cardiovascular care: the PUMA-2 Trial

Doctor Luke Perry, Monash University

Vanguard Grant

Years funded: 2026 - 2027

Each year, over two million people undergo open heart surgery. To guide treatment during and after surgery, doctors often use a device called a pulmonary artery catheter (PAC), an invasive tool inserted into the neck and fed into the heart. However, some studies have raised concerns that PACs may provide inaccurate information, delay recovery, increase interventions and healthcare costs without a proven benefit.

Despite this, PACs are still routinely used in heart surgery. This is the only area of critical care where their use remains widespread, as no randomised trial has ever tested whether they improve patient outcomes compared to a less invasive option: the central venous catheter (CVC).

PUMA-2 is the world’s first randomised clinical trial comparing PACs to CVCs in heart surgery. It will involve over 2,000 patients at major hospitals across Australia and the United States. Patients will be randomly assigned (50/50 chance) to receive either a PAC or a CVC during their operation, and we will track their recovery, complications, survival, quality of life, and experience of care. We will also study the financial and environmental impacts of both devices, and whether certain patient groups are more/less likely to benefit.

PUMA-2 has the potential to change global practice, shield hundreds of thousands of heart surgery patients from a potentially dangerous and unnecessary monitoring device, while also reducing hospital costs and waste. This may lead to lower rates of complications and shorter stays in the intensive care unit, translating to better outcomes for patients and increased bed capacity. These results will help clinicians, hospitals, and policymakers make better-informed decisions.

The trial has been co-designed with patients and their families, leading clinicians, and expert researchers, and builds on years of preparation, including the PUMA Pilot study of 150 patients. Our team includes early-career researchers under the mentorship of Australia’s leading researchers in this field, including cardiac anaesthetists, cardiac surgeons and intensive care specialists, who have a track record of completing similar trials and translating them into global impact.

PUMA-2 has a strong plan to make sure its results lead to real improvements in cardiac surgery. The trial findings will be published in top medical journals read by critical care and cardiac surgery doctors. We are working with 10 strategic partners, including the Australian Commission on Safety and Quality in Health Care, to support changes in hospital practice and national health policy based on PUMA-2.