Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study. (December 2020)

• Record Type: Journal Article
• Authors: Sionis, Alessandro; Rivas-Lasarte, Mercedes; Mebazaa, Alexandre; Tarvasmäki, Tuukka; Sans-Roselló, Jordi; Tolppanen, Heli; Varpula, Marjut; Jurkko, Raija; Banaszewski, Marek; Silva-Cardoso, Jose; Carubelli, Valentina; Lindholm, Matias Greve; Parissis, John; Spinar, Jindrich; Lassus, Johan; Harjola, Veli-Pekka; Masip, Josep
• Is Part Of: Journal of intensive care medicine. Volume 35:Number 12(2020)
• Page Start: 1426
• Page End: 1433
• Publication Date: 2020-12
• Subjects: cardiogenic shock -- mortality -- pulmonary artery catheter -- cardiac index -- stroke volume index -- cardiac power index; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/0885066619828959
• Languages: English
• ISSNs: 0885-0666

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.