Bertaina Maurizio, Galluzzo Alessandro, Rossello Xavier, Sbarra Pierluigi, Petitti Elisabetta, Prever Silvia Brach, Boccuzzi Giacomo, D'Ascenzo Fabrizio, Frea Simone, Pidello Stefano, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Valente Serafina, De Ferrari Gaetano Maria, Ugo Fabrizio, Rametta Francesco, Attisani Matteo, Zanini Paola, Noussan Patrizia, Iannaccone Mario
Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy.
Department of Cardiology, Sant'Andrea Hospital, Vercelli, Italy.
J Crit Care. 2022 Jun;69:154024. doi: 10.1016/j.jcrc.2022.154024. Epub 2022 Mar 25.
To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence.
MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one.
Six observational studies including 1,166,762 patients were selected. The most frequent etiology of CS was post-myocardial infarction (75% [95% CI 55-89%] in PAC-group and 81%[95% CI 47-95%] in non-PAC group). Overall, PAC was used in 33%(95% CI 24-44%) of cases. Pooling data adjusted for confounders, a significant association between the PAC-group and a reduction in short-term mortality emerged when compared to the non-PAC group (36%[95% CI 27-45%] vs 47%[95% CI 35-59%];AdjustedOR 0.71, 95% CI 0.59-0.87, p < 0.01). MCS use was significantly higher in PAC vs non-PAC group (59% [95% CI 54-65%]) vs 48% [95% CI 43-53%]);OR 1.60 [95% CI 1.27-2.02, p < 0.01]).
PAC was associated with lower incidence of short-term mortality in CS pooling adjusted observational studies. Prospective studies are needed to confirm our hypothesis and better clarify the mechanisms of this potential prognostic benefit.
鉴于现有证据存在争议，探讨肺动脉导管（PAC）监测对心源性休克（CS）患者生存的影响。
系统检索MEDLINE、EMBASE、Cochrane图书馆和科学网，以确定关于CS患者在住院期间使用PAC与不使用PAC的最相关研究。短期死亡率是主要终点，机械循环支持（MCS）设备的使用是次要终点。
选择了6项观察性研究，共1,166,762例患者。CS最常见的病因是心肌梗死后（PAC组为75%[95%CI 55 - 89%]，非PAC组为81%[95%CI 47 - 95%]）。总体而言，33%（95%CI 24 - 44%）的病例使用了PAC。汇总经混杂因素调整的数据后，与非PAC组相比，PAC组与短期死亡率降低之间存在显著关联（36%[95%CI 27 - 45%]对47%[95%CI 35 - 59%]；调整后OR为0.71，95%CI 0.59 - 0.87，p < 0.01）。PAC组MCS的使用显著高于非PAC组（59%[95%CI 54 - 65%]对48%[95%CI 43 - 53%]）；OR为1.60[95%CI 1.27 - 2.02，p < 0.01]）。
在汇总的经调整观察性研究中，PAC与CS短期死亡率较低相关。需要进行前瞻性研究以证实我们的假设，并更好地阐明这种潜在预后益处的机制。
