The following is a summary of “Invasive mechanical ventilation in cardiogenic shock complicating acute myocardial infarction: A contemporary Danish cohort analysis,” published in the June 2024 issue of Cardiology by Povlsen et al.

Despite the widespread use of invasive mechanical ventilation (IMV) for cardiogenic shock arising from acute myocardial infarction (AMICS), optimal treatment practices lack substantial evidence.

Researchers conducted a retrospective study to assess trends in IMV use, settings, and short-term outcomes in patients with AMICS receiving IMV upon admission following out-of-hospital cardiac arrest (OHCA).

They studied consecutive patients with AMICS receiving IMV in an ICU at two tertiary centers (2010 and 2017), with data analyzed about OHCA.

The results showed 1,274 IMV patients with AMICS, with 682 (54%) having OHCA identified. The IMV frequency increased over the study period due to more OHCA admissions. In 566 patients with complete ventilator data, initial 24-hour ICU monitoring included positive-end-expiratory pressure, inspired oxygen fraction, and minute ventilation. No differences in ventilator requirements were found between 30-day survivors and non-survivors with OHCA. In patients with non-OHCA, 30-day non-survivors had significantly higher ventilator requirements (P<0.05), a lower PaO₂/FiO₂ ratio (median 143 vs. 230, P<0.001), and higher arterial lactate levels (median 3.5 vs. 1.5 mmol/L, P<0.001) than survivors. Normal PaO₂ and pCO₂ levels were achieved in all patients regardless of 30-day survival and OHCA status.

Investigators concluded that while patients with OHCA and non-OHCA AMICS initially achieved normal blood gas levels, only increased ventilation needs in patients with non-OHCA predicted poorer survival.

Source: sciencedirect.com/science/article/pii/S0167527324003565