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

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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    Abstract

    © The Author(s) 2019. 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.
    Original languageEnglish
    JournalJournal of Intensive Care Medicine
    DOIs
    Publication statusPublished - 1 Jan 2019

    Keywords

    • cardiac index
    • cardiac power index
    • cardiogenic shock
    • mortality
    • pulmonary artery catheter
    • stroke volume index

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    Sionis, A., Rivas-Lasarte, M., Mebazaa, A., Tarvasmäki, T., Sans-Roselló, J., Tolppanen, H., Varpula, M., Jurkko, R., Banaszewski, M., Silva-Cardoso, J., Carubelli, V., Lindholm, M. G., Parissis, J., Spinar, J., Lassus, J., Harjola, V. P., & Masip, J. (2019). Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study. Journal of Intensive Care Medicine. https://doi.org/10.1177/0885066619828959