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Multicenter Study
. 2019 Jun 15:285:6-10.
doi: 10.1016/j.ijcard.2019.03.008. Epub 2019 Mar 6.

Temporal trends and outcomes of prolonged invasive mechanical ventilation and tracheostomy use in acute myocardial infarction with cardiogenic shock in the United States

Saraschandra Vallabhajosyula  1 , Shannon M Dunlay  2 , Kianoush Kashani  3 , Shashaank Vallabhajosyula  4 , Saarwaani Vallabhajosyula  5 , Pranathi R Sundaragiri  6 , Allan S Jaffe  5 , Gregory W Barsness  5
Affiliations
Multicenter Study

Temporal trends and outcomes of prolonged invasive mechanical ventilation and tracheostomy use in acute myocardial infarction with cardiogenic shock in the United States

Saraschandra Vallabhajosyula et al. Int J Cardiol. .

Abstract

Background: There are limited data on prolonged invasive mechanical ventilation (IMV) and tracheostomy use in intubated acute myocardial infarction with cardiogenic shock (AMI-CS) patients.

Methods: Using the National Inpatient Sample, all admissions with AMI-CS requiring IMV between January 1, 2000, and December 31, 2014, were included. Prolonged IMV was defined as IMV use >96 h. Outcomes of interest included temporal trends in use of prolonged IMV and tracheostomy, in-hospital mortality, and resource utilization.

Results: In this 15-year period, 185,589 intubated AMI-CS admissions met the inclusion criteria. Prolonged IMV (>96 h) and tracheostomy use were noted in 68,544 (36.9%) and 10,645 (5.7%), respectively. Prolonged IMV and tracheostomy were used more commonly in younger patients. The cohort with prolonged IMV had higher organ failure and greater use of cardiac and non-cardiac organ support. Temporal trends showed a decline in prolonged IMV (adjusted odds ratio {aOR} 0.61 [95% confidence interval {CI} 0.57-0.65]) and tracheostomy use (aOR 0.80 [95% CI 0.70-0.90]) in 2014 compared to 2000. Prolonged IMV (aOR 0.45 [95% CI 0.44-0.47]; p < 0.001) and tracheostomy (aOR 0.28 [95% CI 0.27-0.29]; p < 0.001) were associated with lower in-hospital mortality with a decreasing trend between 2000 and 2014 in intubated AMI-CS admissions. Patients with prolonged IMV and tracheostomy use had nearly three-fold higher health care costs, and four-fold longer hospital stays.

Conclusions: In this cohort of intubated AMI-CS admissions, prolonged IMV and tracheostomy showed a temporal decrease between 2000 and 2014. Prolonged IMV and tracheostomy use was associated with high resource utilization.

Keywords: Acute myocardial infarction; Acute respiratory failure; Cardiogenic shock; Critical care cardiology; Prolonged mechanical ventilation; Tracheostomy.

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