Abstract 9436: Impact of Pulmonary Artery Catheter Use in Cardiogenic Shock: A Systematic Review

Abstract

Introduction: Randomized controlled trials and systematic reviews evaluating the use of pulmonary artery catheters in the critically ill population have not shown beneficial effects on survival. However, many of those studies have excluded patients in cardiogenic shock. We address this evidence gap by providing a comprehensive meta-analysis to investigate the association between pulmonary artery catheter use and outcomes in patients with cardiogenic shock Hypothesis: Pulmonary artery catheter use in patients with cardiogenic shock is associated with improved mortality. Methods: We performed an extensive literature search using PubMed, MEDLINE, SCOPUS, and the Cochrane databases from January 1990 through June 2021. Data for final analysis was pooled using a random effects model. Odds ratios were used for effect size. Information on eligibility criteria, outcomes, and methodological quality was extracted by two independent reviewers. Primary study outcome was in-hospital mortality rate. Results: 16 studies were included in the analysis comprising 2,400,618 patients. Of those, 212,122 were managed with a pulmonary artery catheter (8.8%) and 2,188,496 were managed without one (91.2%). In patients with cardiogenic shock, pulmonary artery catheter use was associated with a statistically significant decrease in mortality (OR 0.82 [95% CI 0.73-0.92; p = 0.001]. The pulmonary artery catheter cohort was more likely to receive mechanical circulatory support (OR 2.16 [95% CI 1.90-2.45; p<0.001]), left ventricular assist device (OR 3.09 [95% CI 1.96-4.86; p<0.001]), and renal replacement therapy (OR 1.44 [95% CI 1.17-1.77; p=0.001]). Interestingly, when studies looking only at patients who developed cardiogenic shock due to acute myocardial infarction were analyzed, there was no statistically significant improvement in mortality (OR 0.945 [95% CI 0.75-1.20; p=0.64]). Conclusions: Pulmonary artery catheter use in patients with cardiogenic shock is associated with lower in-hospital mortality. Future studies differentiating pulmonary artery catheter use among various cardiogenic shock stages and phenotypes are needed.