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

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  • 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
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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.

OriginalsprogEngelsk
TidsskriftJournal of Intensive Care Medicine
Vol/bind35
Udgave nummer12
Sider (fra-til)1426-1433
Antal sider8
ISSN0885-0666
DOI
StatusUdgivet - dec. 2020

ID: 59121119