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. 
Average of 3 thermodilution measurements required

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.
Core temperature
Mixed venous blood samples for ScVO2

Anatomical information regarding cardiac structure

Realtime observation of cardiac function

Risks

Haemorrhage/vascular access risks
Pulmonary artery rupture and haemorhage
Right heart valve damage
Right ventricular damage
Knotting inside right ventricle
Arrhythmias

Oesophageal perforation
Oral cavity damage
Risk associated with sedation and anaesthesia

Advantages

Continuous monitoring technique

Able to acquire blood samples

Minimally invasive

Disadvantages

Invasive; significant risks of insertion

Intermittent monitoring technique

No sampling possible