Differences in management and prognostication of Cardiogenic Shock patients in the presence and absence of Out-of-hospital Cardiac arrest.

BackgroundThe clinical spectrum of acute myocardial infarction complicated by cardiogenic shock (AMICS) varies. Out-of-hospital cardiac arrest (OHCA) can be the first sign of cardiac failure, whereas others present with various degrees of hemodynamic instability (non-OHCA). Aim of the present study was to explore differences in pre-hospital management and characteristics of survivors and non-survivors in AMICS patients with OHCA or non-OHCA.MethodsData analysis was based on patient data from the RETROSHOCK cohort comprising consecutive AMICS patients admitted to two tertiary cardiac centers between 2010-2017.Results1,716 AMICS patients were included and 42% presented with OHCA. Mortality in OHCA patients was 47% versus 57% in the non-OHCA group. Almost all OHCA patients were intubated prior to admission (96%). In the non-OHCA group prehospital intubation (25%) was associated with a better survival (p < 0.001). Lactate level on admission demonstrated a linear relationship with mortality in OHCA patients. In non-OHCA probability of death was higher for any given lactate level < 12 mmol/L compared with OHCA. However, a lactate level > 7 mmol/L in non-OHCA did not increase mortality odds any further.ConclusionMortality was almost doubled for any admission lactate level up to 7 mmol/L in non-OHCA patients. Above this level, mortality remained unchanged in non-OHCA patients, but continued to increase in OHCA patients. Prehospital intubation was performed in almost all OHCA patients, but only in one of four patients without OHCA. Early intubation in non-OHCA patients was associated with a better outcome.