Ventilation Strategies in Cardiogenic Shock: Insights from the AltShock-2 Registry

Overview

Journal Eur J Heart Fail

Publisher Wiley

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 6

PMID 39105476

Authors

Alice Sacco

Andrea Montisci

Giovanni Tavecchia

Simone Frea

Davide Bernasconi

Costanza N J Colombo

Stephanie Bertolin

Giovanna Viola

Luca Villanova

Martina Briani

Lisa Patrini

Pier Paolo Bocchino

Carlotta Sorini Dini

Nicoletta DEttore

Maurizio Bertaina

Mario Iannaccone

Luciano Potena

Letizia Bertoldi

Serafina Valente

Rita Camporotondo

Marco Marini

Matteo Pagnesi

Marco Metra

Gaetano De Ferrari

Fabrizio Oliva

Nuccia Morici

Federico Pappalardo

Guido Tavazzi

Affiliations

Soon will be listed here.

Abstract

Aims: To describe the use and the relation to outcome of different ventilation strategies in a contemporary, large, prospective registry of cardiogenic shock patients.

Methods And Results: Among 657 patients enrolled from March 2020 to November 2023, 198 (30.1%) received oxygen therapy (OT), 96 (14.6%) underwent non-invasive ventilation (NIV), and 363 (55.3%) underwent invasive mechanical ventilation (iMV). Patients in the iMV group were significantly younger compared to those in the NIV and OT groups (63 vs. 69 years, p < 0.001). There were no significant differences between groups regarding cardiovascular risk factors. Patients with SCAI B and C were more frequently treated with OT and NIV compared to iMV (65.1% and 65.4% vs. 42.6%, respectively, p > 0.001), while the opposite trend was observed in SCAI D patients (12% and 12.2% vs. 30.9%, respectively, p < 0.001). All-cause mortality at 24 h did not differ amongst the three groups. The 60-day mortality rates were 40.2% for the iMV group, 26% for the OT group, and 29.3% for the NIV group (p = 0.005), even after excluding patients with cardiac arrest at presentation. In the multivariate analysis including SCAI stages, NIV was not associated with worse mortality compared to iMV (hazard ratio 1.97, 95% confidence interval 0.85-4.56), even in more severe SCAI stages such as D.

Conclusions: Compared to previous studies, we observed a rising trend in the utilization of NIV among cardiogenic shock patients, irrespective of aetiology and SCAI stages. In this clinical scenario, NIV emerges as a safe option for appropriately selected patients.

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