Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry.

Abstract

Despite scarce data, invasive mechanical ventilation(MV) is widely suggested as first-line ventilatory support incardiogenic shock(CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis. FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30days and 1year between the three groups. Seven hundred sixty-eight patients were included in this analysis. Mean age was 66years and 71% were men. Among them, 359 did not receive any ventilatory support (46.7%), 118 only NIV (15.4%), and 291 MV (37.9%). MV patients presented more severe CS with more skin mottling, higher lactate levels, and higher use ofvasoactive drugs and mechanical circulatory support. MV was associated with higher mortality and MAE at 30days (HR 1.41 [1.05-1.90] and 1.52 [1.16-1.99] vs NV). No difference in mortality (HR 0.79 [0.49-1.26]) or MAE (HR 0.83 [0.54-1.27]) was found between NIV patients and NV patients. Similar results were found at 1-year follow-up. Our study suggests that using NIV is safe in selected patients with less profound CS and no other MV indication. NCT02703038.