"Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis".

BACKGROUND: Pulmonary artery catheterization (PAC) has been widely used in critically ill patients, yielding mixed results. Prior studies on cardiogenic shock (CS) predominantly included patients with acute myocardial infarction. This study aims to examine the effect of PAC use in patients with non-ischemic CS.

METHODS: This retrospective cohort study employed data from the National Inpatient Sample (NIS) database, including weighted hospitalizations of adult patients with non-ischemic CS during 2017 to 2019. In-hospital outcomes were compared between groups using inverse probability of treatment weighting.

RESULTS: A total of 303,970 patients with non-ischemic CS were included, of whom 17.5% received a PAC during their hospitalization. The median age was 67 years (interquartile range: 57 - 77) and 61% were male. After inverse probability of treatment weighting, patients in the PAC group had significantly lower in-hospital mortality (24.8% vs. 35.3%, p < 0.001), renal replacement therapy (10.7% vs. 12.4%, p = 0.002), in-hospital cardiac arrest (7.1% vs. 9.6%, p < 0.001), and mechanical ventilation (44.6% vs. 50.4%, p < 0.001) compared to non-PAC group. In contrast, the PAC group had higher use of intra-aortic balloon pump (15.4% vs. 3.4%, p < 0.001), percutaneous ventricular assist devices (12.6% vs. 2.6%, p < 0.001), extracorporeal membrane oxygenation (3.9% vs. 2.5%, p < 0.001), and heart transplantation (2.1% vs. 0.4%, p < 0.001).

CONCLUSION: In the real-world setting, invasive hemodynamic monitoring with PAC in patients with non-ischemic CS is associated with survival benefits and a reduction in adverse events, including reduced need for renal replacement therapy, mechanical ventilation and risk of in-hospital cardiac arrest.