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Observational Study
. 2025 Oct;114(10):1311-1323.
doi: 10.1007/s00392-024-02551-x. Epub 2024 Oct 23.

Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry

Kim Volle  1 , Hamid Merdji  2 , Vincent Bataille  3 , Nicolas Lamblin  4 , François Roubille  5 , Bruno Levy  6 , Sebastien Champion  7 , Pascal Lim  8 , Francis Schneider  9 , Vincent Labbe  10 , Hadi Khachab  11 , Jeremy Bourenne  12 , Marie-France Seronde  13 , Guillaume Schurtz  4 , Brahim Harbaoui  14 , Gerald Vanzetto  15 , Charlotte Quentin  16 , Nicolas Combaret  17 , Benjamin Marchandot  18 , Benoit Lattuca  19 , Caroline Biendel  1 , Guillaume Leurent  20 , Laurent Bonello  21 , Edouard Gerbaud  22   23 , Etienne Puymirat  24   25 , Eric Bonnefoy  26 , Nadia Aissaoui  27 , Clément Delmas  28   29   30   31 ; FRENSHOCK Investigator
Collaborators, Affiliations
Observational Study

Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry

Kim Volle et al. Clin Res Cardiol. 2025 Oct.

Abstract

Background: Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis.

Methods: FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30 days and 1 year between the three groups.

Results: Seven hundred sixty-eight patients were included in this analysis. Mean age was 66 years and 71% were men. Among them, 359 did not receive any ventilatory support (46.7%), 118 only NIV (15.4%), and 291 MV (37.9%). MV patients presented more severe CS with more skin mottling, higher lactate levels, and higher use of vasoactive drugs and mechanical circulatory support. MV was associated with higher mortality and MAE at 30 days (HR 1.41 [1.05-1.90] and 1.52 [1.16-1.99] vs NV). No difference in mortality (HR 0.79 [0.49-1.26]) or MAE (HR 0.83 [0.54-1.27]) was found between NIV patients and NV patients. Similar results were found at 1-year follow-up.

Conclusions: Our study suggests that using NIV is safe in selected patients with less profound CS and no other MV indication. NCT02703038.

Keywords: Cardiogenic shock; Mechanical ventilation; Mortality; Non-invasive ventilation; Prognosis.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
30 day survival according to the maximal level of ventilatory support used during hospitalization
Fig. 2
Fig. 2
30 day survival free from heart transplantation or LVAD/BiVAD support according to the maximal level of ventilatory support used during hospitalization. BiVAD, biventricular assist device or total artificial heart; LVAD, left ventricular assist device
See this image and copyright information in PMC

References

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