Development and Testing of a Novel Anaesthesia Induction/Ventilation Protocol for Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction.

BACKGROUND: Cardiogenic shock is a life-threatening condition and patients might require rapid sequence induction (RSI) and mechanical ventilation. In this study, we evaluated a new RSI/mechanical ventilation protocol in patients with acute myocardial infarction complicated by cardiogenic shock.

METHODS: We included consecutive adult patients who were transferred to the emergency department. The RSI protocol included 5 phases: preoxygenation, pretreatment, induction/paralysis, intubation, and mechanical ventilation (PPIIM). A posteriori, we selected historical patients managed with standard RSI as a control group. The primary outcome was hemodynamic derangement or hypoxemia from enrollment until intensive care unit (ICU) admission.

RESULTS: We studied 31 consecutive patients who were intubated using the PPIIM protocol and 22 historical controls. We found significant differences in systolic (85.32 ± 4.23 vs 71.72 ± 7.98 mm Hg; P < 0.0001), diastolic (58.84 ± 5.84 vs 39.05 ± 5.63 mm Hg; P < 0.0001), and mean arterial pressure (67.71 ± 4.90 vs 49.90 ± 5.66 mm Hg; P < 0.0001), as well as in partial pressure of oxygen (85.80 ± 19.82 vs 164.73 ± 43.07 mm Hg; P < 0.0001) between the PPIIM and control group at 5 minutes of automated ventilation. Also, statistically significant differences were observed in diastolic (59.74 ± 4.93 vs 47.86 ± 11.47 mm Hg; P < 0.0001) and mean arterial pressure (68.65 ± 4.10 vs 60.23 ± 11.67 mm Hg; P < 0.0001), as well as in partial pressure of oxygen (119.84 ± 50.57 vs 179.50 ± 42.17 mm Hg; P < 0.0001), and partial pressure of carbon dioxide (39.81 ± 10.60 vs 31.00 ± 9.30 mm Hg; P = 0.003) between the 2 groups at ICU admission. Compared with the control group, with PPIIM more patients survived to ICU admission (100% vs 77%) and hospital discharge (71% vs 31.8%), as well as at 90 days (51.6% vs 18.2%), and at 180 days (38.7% vs 13.6%).

CONCLUSIONS: The PPIIM protocol allows safe intubation of acute myocardial infarction patients with cardiogenic shock and improves hemodynamic and oxygenation parameters.