BACKGROUND: Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV. METHODS: 219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24h into MV (n=137; 63%) , NIV (n=26; 12%), and supplementary oxygen (n=56; 26%) groups. We compared the clinical characteristics and 90-day outcome between the MV and the NIV groups. RESULTS: Mean age was 67years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO2/FiO2 ratio, baseline hemodynamics or LVEF. MV patients predominantly presented with hypoperfusion, with more severe metabolic acidosis, higher lactate levels and greater need for vasoactive drugs, whereas NIV patients tended to be more often congestive. 90-day outcome was significantly worse in the MV group (50% vs. 27%), but after propensity score adjustment, mortality was equal in both groups. Confusion, prior CABG, ACS etiology, higher lactate level, and lower baseline PaO2 were independent predictors of mortality, whereas ventilation strategy did not have any influence on outcome. CONCLUSIONS: Although MV is generally recommended mode of ventilatory support in CS, a fair number of patients were successfully treated with NIV. Moreover, ventilation strategy was not associated with outcome. Thus, NIV seems a safe option for properly chosen CS patients.

Attikon University Hospital Heart Failure Clinic and Secondary Cardiology Department Athens Greece

Department of Medical Sciences and Translational Medicine University of Rome Sapienza Emergency Medicine Sant'Andrea Hospital Rome Italy

Division of Cardiology Department of Medical and Surgical Specialties Radiological Sciences and Public Health University and Civil Hospital of Brescia Italy

Emergency Medicine University of Helsinki Department of Emergency Care Helsinki University Hospital Helsinki Finland

Helsinki University Hospital Heart and Lung Center Division of Cardiology Helsinki Finland

Institute of Cardiology Intensive Cardiac Therapy Clinic Warsaw Poland

Intensive Cardiac Care Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Biomedical Research Institute Sant Pau Barcelona Spain

Rigshospitalet Copenhagen University Hospital Intensive Cardiac Care Unit Copenhagen Denmark

University Hospital Brno Department of Internal Medicine and Cardiology Brno Czech Republic

University of Barcelona Hospital Sant Joan Despi Moisès Broggi Critical Care Department Consorci Sanitari Integral Barcelona Spain

University of Porto CINTESIS Department of Cardiology Porto Medical School São João Hospital Center Porto Portugal

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