Acute respiratory failure and mechanical ventilation in cardiogenic shock complicating acute myocardial infarction in the USA, 2000–2014

Abstract

Background: There are limited epidemiological data on acute respiratory failure (ARF) in cardiogenic shock complicating acute myocardial infarction (AMI-CS). This study sought to evaluate the prevalence and outcomes of ARF in AMI-CS. Methods: This was a retrospective study of AMI-CS admissions during 2000-2014 from the National Inpatient Sample. Administrative codes for ARF and mechanical ventilation (MV) were used to define the cohorts of no ARF, ARF without MV and ARF with MV. Admissions with a secondary diagnosis of AMI and with chronic MV were excluded. Outcomes of interest included in-hospital mortality, temporal trends of ARF prevalence and resource utilization. Measurements and main results: During 2000-2014, 439,436 admissions for AMI-CS met the inclusion criteria. ARF and MV were noted in 57% and 43%, respectively. Admissions with non-ST-elevation AMI-CS, of non-White race and with non-private insurance received MV more frequently. Noninvasive ventilation and invasive MV increased from 0.4% and 39.2% (2000) to 3.6% and 46.4% (2014), respectively (p < 0.001). Coronary angiography and percutaneous coronary intervention were used less frequently in admissions receiving ARF with MV. Compared to admissions with no ARF, ARF without MV (adjusted odds ratio (aOR) 1.56 [95% confidence interval (CI) 1.53-1.59]; p < 0.001) and ARF with MV (aOR 2.50 [95% CI 2.47-2.54]; p < 0.001) were associated with higher in-hospital mortality. Admissions with ARF without MV had greater resource utilization and lesser discharges to home as compared to no ARF. Conclusions: In this contemporary AMI-CS cohort, the presence of ARF and MV use was noted in 57% and 43%, respectively, and was associated with higher in-hospital mortality.

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

“…During the period between 1 January 2000 through 31 December 2016, a retrospective cohort of admissions from the HCUP-NIS with a primary diagnosis of AMI (International Classification of Disease-9 Clinical Modification [ICD-9CM] 410.x; International Classification of Disease-10 Clinical Modification [ICD-10CM] I21.x-22.x) receiving ECMO support (ICD-9CM 39.65; ICD-10CM 5A15223) were identified consistent with prior literature [7]. Deyo's modification of Charlson Comorbidity Index was used to identify co-morbid diseases and prior methodology was used to identify cardiac and non-cardiac procedures [2,3,7,8,11,[13][14][15][16][17][18][19][20][21][22][23]. We identified relevant complications and categorized them as (a) vascular complications-arterial injury, acquired arterio-venous fistula, and vascular complications requiring surgery; (b) lower limb amputation; (c) hematologic-post-operative hemorrhage, hemolytic anemia, thrombocytopenia, and blood transfusion; and (d) neurologic-ischemic or hemorrhagic stroke ( Supplementary Table S1).…”

“…Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute cardiovascular care for the management of acute myocardial infarction (AMI) complicated by cardiac arrest, cardiogenic shock and complications from cardiac interventional procedures [1][2][3][4][5][6][7][8][9][10]. ECMO provides cardiac output support of nearly 3-5 L, biventricular support and respiratory support, thereby assisting with critical cardiorespiratory support in extreme situations [11]. Despite limited data and the absence of randomized controlled trials, ECMO has been widely accepted in clinical practice [2][3][4][5][6][7][8].…”

Epidemiological Trends in the Timing of In-Hospital Death in Acute Myocardial Infarction-Cardiogenic Shock in the United States

“…The timing of in-hospital events, including IHD remains underexplored in critical illness [1,8,15]. In a nationally-representative population of STEMI admissions that received primary PCI, we previously demonstrated that ventricular arrhythmias were predominant in early in-hospital cardiac arrest, whereas non-shockable rhythms and multi-organ involvement were prevalent in the delayed group [13].…”

“…In AMI-CS, most mortality analyses and predictive models have used IHD, 28-day or 30-day mortality as the end-points, with little additional granularity on the timing of IHD during the index hospitalization [10]. Previous work from our group has demonstrated that AMI-CS patients frequently transition to invasive mechanical ventilation in the first two days, as well as a temporal decrease in the use of prolonged mechanical ventilation and tracheostomy use in the United States [15,20]. Taken in aggregate, these data might suggest that there have been improvements in care delivery for this acutely ill population, decreasing the burden of chronic critical illness [11].…”

Influence of seasons on the management and outcomes acute myocardial infarction: An 18‐year US study

“…The four geographic regions included the Northeast, Midwest, South, and West as classified by the HCUP‐NIS 35 . Similar to prior literature, we defined early coronary angiography as that performed on the day of hospital admission (day 0) 31,42,43 . We identified timing of coronary angiography and percutaneous coronary intervention (PCI) relative to the day of admission 18,31,41,42 …”