Abstract 14409: Elucidating Clinical Phenotypes of Patients With Mixed Shock Admitted to Cardiac Intensive Care Units: Insights From the Critical Care Cardiology Trials Network

Abstract

Background: Emerging data suggests that patient with mixed cardiogenic and vasodilatory shock have high morbidity and mortality; however, this population is still poorly understood and is not well-characterized. Methods: The Critical Care Cardiology Trials Network is a multicenter network of advanced cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Each CICU contributed an annual 2-month period of all consecutive medical CICU admissions from 2017-2020 (n=13,300). Mixed shock (MS) subjects were stratified into those with acute MI (AMI-MS) and those without (non-AMI-MS). Results: Among 3884 CICU admissions with shock, 840 (22%) presented with MS; 169 AMI-MS and 671 non-AMI-MS. Mean age was 66y, 37.1% were female, and 69.5% were white. Median Sequential Organ Failure Assessment was 10.0 (25 th -75 th %ile, 7.0-12.5). On presentation, AMI-MS had more end-organ injury: lactate (3.5 vs. 2.7, p < 0.01) & AST (126 vs. 54, p < 0.01). AMI-MS had fewer CV & non-CV comorbidities ( p < 0.01 for all). Sepsis was less common in AMI-MS (47.8% vs. 67.6%, p < 0.0001). Use of advanced ICU therapies was high, as 25.4% overall cohort required renal replacement therapy (RRT). AMI-MS required more mechanical ventilation (81.1% vs. 67.5%, p < 0.001), invasive cardiac procedures (76.3% vs. 16.2%, p < 0.0001), and temporary mechanical support (tMCS) (56.8% vs. 16.7%, p < 0.0001). Both AMI-MS and non-AMI-MS patients had high in-hospital mortality (50.3% [95% CI 42.5% - 58.1%] & 43.5% [95% CI 39.7% - 47.4%], respectively). AMI-MS patients with a worst pH < 7.25, ≥ 3 pressors, and RRT use have a 4.9-fold, 3.9-fold, and 2.9-fold risk of in-hospital mortality, respectively (Figure). Conclusion: In a contemporary multicenter analysis of advanced CICUs, patients with mixed shock have high in-hospital mortality and frequent need for advanced ICU therapies. Patients with AMI-MS present with particularly high shock severity and subsequent resource utilization.