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.

Sacco, A., Montisci, A., Tavecchia, G., Frea, S., Bernasconi, D., Colombo, C., et al. (2024). Ventilation strategies in cardiogenic shock: Insights from the AltShock-2 registry. EUROPEAN JOURNAL OF HEART FAILURE [10.1002/ejhf.3409].

Ventilation strategies in cardiogenic shock: Insights from the AltShock-2 registry

Tavecchia G.;Bernasconi D.;Oliva F.;
2024

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.
Articolo in rivista - Articolo scientifico
Cardiogenic shock; Invasive mechanical ventilation; Mechanical ventilation; Non-invasive ventilation; Positive pressure ventilation;
English
6-ago-2024
2024
none
Sacco, A., Montisci, A., Tavecchia, G., Frea, S., Bernasconi, D., Colombo, C., et al. (2024). Ventilation strategies in cardiogenic shock: Insights from the AltShock-2 registry. EUROPEAN JOURNAL OF HEART FAILURE [10.1002/ejhf.3409].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/521888
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