In-hospital mortality associated with invasive mechanical ventilation in cardiogenic shock: a weighted national analysis of the 2021 nationwide inpatient sample
R Levy, C G GracidasAbstract
Background/Introduction
Cardiogenic shock (CS) remains associated with high in-hospital mortality. Invasive mechanical ventilation (IMV) is frequently required in patients with haemodynamic instability; however, its association with mortality in contemporary national cohorts is not well characterised.
Purpose
To evaluate the association between IMV use and in-hospital mortality among hospitalisations with CS in the United States.
Methods
We performed a retrospective analysis of the 2021 Nationwide Inpatient Sample. Adult hospitalisations with cardiogenic shock were identified using validated administrative coding. Survey weights were applied to generate national estimates. Weighted mortality rates were calculated using survey-adjusted methods. Multivariable logistic regression accounting for survey design was performed to assess the association between IMV and in-hospital mortality, adjusting for age, sex, race, primary payer, median income quartile, hospital teaching status and hospital region.
Results
A weighted total of 215,830 hospitalisations with CS were identified. IMV was used in 95,525 (44.3%) cases. In-hospital mortality was significantly higher in patients receiving IMV compared with those not receiving IMV (52.0% vs 18.6%, p<0.001). In unadjusted analysis, IMV was associated with increased odds of mortality. After multivariable adjustment, IMV remained independently associated with in-hospital mortality (adjusted OR 5.26, 95% CI 5.03–5.51; p<0.001).
Conclusion(s)
In a contemporary nationally representative cohort, IMV use in cardiogenic shock was strongly associated with increased in-hospital mortality, even after adjustment for patient and hospital characteristics. These findings highlight the severe risk profile of mechanically ventilated patients with CS and underscore the need for strategies aimed at earlier intervention and optimisation of respiratory and haemodynamic support.