Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study.

Abstract

BACKGROUND:

Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC).

METHODS:

Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes.

RESULTS:

Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score.

CONCLUSIONS:

In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.

• Authors: Alessandro Sionis, Mercedes Rivas-Lasarte, Alexandre Mebazaa, Tuukka Tarvasmäki, Jordi Sans-Roselló, Heli Tolppanen, Marjut Varpula, Raija Jurkko, Marek Banaszewski, Jose Silva-Cardoso, Valentina Carubelli, Matias Greve Lindholm, John Parissis, Jindrich Spinar, Johan Lassus, Veli-Pekka Harjola, Josep Masip
• Journal: Journal of intensive care medicine (J Intensive Care Med) Vol. 35 Issue 12 Pg. 1426-1433 (Dec 2020) ISSN: 1525-1489 [Electronic] United States
• PMID: 30732522 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Topics

• Catheterization, Swan-Ganz
• Catheters
• Hospital Mortality
• Humans
• Prospective Studies
• Pulmonary Artery
• Shock, Cardiogenic (mortality, therapy)