(P036) PULMONARY ARTERY CATHETER MONITORING AND OUTCOMES IN CARDIOGENIC SHOCK: INSIGHTS FROM A TERTIARY CENTER COHORT STUDY

Background: Despite advances in care, cardiogenic shock (CS) mortality remains high. The use of pulmonary artery catheters (PACs) had fallen out of favour because of an apparent lack of benefit in other shock states. However, invasive hemodynamic monitoring with PACs can aid both in diagnosis and guide on-going therapies, including the use of temporary mechanical circulatory support (tMCS). Indeed, recent reports showed that PAC assessment prior to tMCS initiation was associated with lower in-hospital mortality in CS. Another meta-analysis suggested that the benefit of PACs was predominantly in acute decompensated HF with no benefit in CS in the context of myocardial infarction. As such, PAC use continues to vary greatly according to institutional preference. We therefore sought to evaluate how PAC monitoring has evolved in our tertiary-care cardiac intensive care unit (CICU) and whether we could identify patient populations that stand to derive more benefit from PAC in order to guide local quality improvement initiatives.

METHODS AND RESULTS: All patients admitted to the CICU with CS SCAI B or higher of any cause from March 2019 to March 2023 were included in our analysis. A Historic Cohort was defined as patients admitted from March 2019 to April 2021 and the Contemporary Cohort was made of patients admitted from May 2021 to January 2023. Demographic and clinical data were extracted from the electronic medical records. CICU mortality was compared using the chi-square test. A total of 281 patients are included in this analysis (161 Historic, 120 Contemporary). Demographic data is comparable over time with an average age of 68.7 ± 12.7 years and 27.0% female patients overall. CICU mortality was not different across cohorts (35.4% Historic vs 36.7% Contemporary), and PAC use also changed little over time (9.4% vs 9.8%, p>0,05). Mortality did not differ based on PAC use, unless patients received tMCS. In the Contemporary Cohort, for example, patients with PAC who received tMCS had 0% mortality compared to 22% for those without PAC monitoring.

Conclusion: Despite recent observational data supporting PAC use in CS, only a very small portion of patients are monitored with a PAC in our CICU. However, in line with those same studies, we observed a lower mortality among tMCS patients with PAC use in our center. Emphasizing the importance of PAC use in this subset of CS patients would therefore be an important first step toward increasing the use of PACs in CS and overall quality of care.