The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.

There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency.

PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs.

Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care.

Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology.

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