Medical Doctor Mayo Clinic Jacksonville, Florida, United States
Introduction: Cardiogenic shock presents a severe clinical challenge with elevated morbidity and mortality rates. Pulmonary artery catheters (PACs) are utilized for continuous hemodynamic monitoring, potentially guiding better management strategies in this critical condition. The impact of PAC use on in-hospital outcomes, including mortality rates, has been debated. This study investigates trends in PAC utilization and its association with in-hospital mortality among patients with cardiogenic shock using a comprehensive national dataset.
Methods: We analyzed National Inpatient Sample (NIS) data from 2016 to 2020 to identify hospitalizations for cardiogenic shock. PAC use was determined through ICD-10 Procedure Coding System (PCS) codes. Trends in PAC utilization and in-hospital mortality were assessed using line graphs. Differences in mortality between patients who received PAC and those who did not were evaluated using Chi-Square tests for each year.
Results: A total of 763,145 admissions for cardiogenic shock were analyzed, with a mean age of 64 years (SD = 12.5) and a predominance of male patients (68%). The cohort comprised 63.7% White, 20.9% Black, and 7.9% Hispanic/Latinx individuals. Pulmonary artery catheter (PAC) was utilized in 6.2% of admissions, with usage increasing from 5.2% in 2016 to 6.4% in 2020. The mean in-hospital mortality rate over the 5-year period was 33.5%. PAC use was associated with a significantly lower incidence of in-hospital mortality (24.8% vs. 34.4%, p < 0.001). Additionally, overall in-hospital mortality decreased from 35.2% in 2016 to 33.2% in 2020.
Conclusions: The use of pulmonary artery catheters (PACs) in patients with cardiogenic shock is associated with a significantly lower incidence of in-hospital mortality compared to non-PAC management. Although overall mortality rates have decreased over time, PAC utilization appears to offer additional survival benefits in this critical patient population.
