(1660) Pulmonary Catheter Utilization and Mortality Trends in Cardiogenic Shock: A Retrospective Study

Introduction: Despite its role in assessing and maintaining optimum volume status, several studies failed to demonstrate any survival benefit with continuous pulmonary artery catheter (PAC)-based monitoring in cardiogenic shock patients. However, with the evolving standard of care, there remains an interest in looking at the trend of PAC utilization and associated mortality rates over time.

Methods: This retrospective single-center study utilized data obtained from the Medical Information Mart for Intensive Care (MIMIC-IV) database to identify adult ICU patients admitted with cardiogenic shock (ICD-9CM 785.51, ICD-10CM R57.0) between 2008 and 2019. Patients with missing data and any readmissions were excluded. Categorical variables were expressed as percentages and were compared using chi-square tests; continuous variables were expressed as median (IQR) and compared using independent sample median tests.

Results: The overall cohort included 1193 patients, among whom 93 (7.80%) underwent PAC placement. Based on the timing of admission, the overall patient cohort was divided into 4 subcohorts: 2008-2010 (193 patients), 2011-2013 (240 patients), 2014-2016 (365 patients), and 2017- 2019 (395 patients). There was no difference in the distribution of age, gender, or Charlson comorbidity score across these groups. However, there was an increasing prevalence of congestive heart failure (66.32% vs. 65.83% vs. 75.89% vs. 79.24%, P< 0.001), percutaneous LVAD use (1.55% vs. 2.92% vs. 2.47% vs. 9.37%, p< 0.001) in recent years. We noted a gradual increase in PAC utilization (4.15% vs. 5.00% vs. 4.93% vs. 13.92%, p< 0.001) over this time as well. Upon comparing mortality rates among patients without PAC versus those who were supported with PAC, we noted significantly reduced mortality rates in the PAC group over recent years: 2008-2010 (44.32% vs 37.50%, p=0.70), 2011-2013 (42.54% vs 25%, p=0.23), 2014-2016 (35.16% vs 11.11%, p=0.03), and 2017- 2019 (41.47% vs 21.82%, p=0.006).

Conclusions: This retrospective study demonstrated increasing PAC utilization rates as well as reduced mortality rates associated with PAC use in a cardiogenic shock population over recent years. Further prospective studies are warranted to re-evaluate the role of PAC in the context of the current standard of care.