The PUMA Pilot: comparing pulmonary artery catheters and venous catheters

Doctor Luke Perry, The University of Melbourne

Postgraduate Scholarship

Years funded: 2025 - 2027

Comparing an invasive monitoring device to a simpler alternative to improve outcomes of open heart surgery. "Over 2 million patients undergo open heart surgery every year, and 1 in 4 will suffer a major complication. Pulmonary artery catheters are frequently used to assess cardiac function and guide management in open heart surgery. However, observational studies have suggested they may trigger unnecessary and invasive treatments, increase complications, and prolong the need for postoperative life support. Pulmonary artery catheters have never been rigorously tested in a randomised controlled trial (RCT), so there is uncertainty about their appropriateness in routine cardiac surgical practice.

I recently obtained full funding ($140,000) from the Heart Foundation (VG106880) and the ANZCA Foundation (23/020) to conduct the PUMA Pilot, the first randomised trial of pulmonary artery catheter use in low-risk cardiac surgery. This study will recruit 150 adults undergoing low-risk cardiac surgery across sites in Australia, Switzerland, and the US, and allocate them randomly to receive a pulmonary artery catheter, or a simpler alternative called a central venous catheter. The primary objective is to test the feasibility and acceptability of conducting a larger, definitive trial. Secondary objectives include exploring the impact of pulmonary artery catheter use on therapeutic decisions, such as the intensity of life support. My PhD will include the following additional studies: (1) a mechanisic study using a comprehensive Harvard database; (2) target trial emulations that employ advanced causal inference models and big data; (3) a health economic analysis of routine pulmonary artery catheter use; (4) a novel consumer focus group; and (5) a Cochrane Review.

The PUMA Pilot will power a world-first multicentre RCT (PUMA II) that will define clinical practice and policy for perioperative management of millions of heart surgery patients globally. This research has public health and economic implications and could potentially shield millions of patients from a low-value and dangerous invasive monitoring device, translating into simplified and value-based care, reduced disability and death, and increased ICU bed capacity.