Modes of Death in Patients with Cardiogenic Shock in the Cardiac Intensive Care Unit: A Report from the Critical Care Cardiology Trials Network.

BACKGROUND: There are limited data on how patients with cardiogenic shock (CS) die.

METHODS: CCCTN is a research network of cardiac intensive care units coordinated by the TIMI Study Group (Boston, MA). Using standardized definitions, site investigators classified direct modes of in-hospital death for CS admissions (10/2021-09/2022). Mutually exclusive categories included 4 modes of cardiovascular death and 4 modes of non-cardiovascular death. Subgroups defined by CS type, preceding cardiac arrest (CA), use of temporary mechanical circulatory support (tMCS), and transition to comfort measures were evaluated.

RESULTS: Among 1,068 CS cases, 337 (31.6%) died during the index hospitalization. Overall, mode of death was cardiovascular in 82.2%. Persistent CS was the dominant specific mode of death (66.5%), followed by arrhythmia (12.8%), anoxic brain injury (6.2%), and respiratory failure (4.5%). Patients with preceding CA were more likely to die from anoxic brain injury (17.1% vs. 0.9%;p<0.001) or arrhythmia (21.6% vs. 8.4%;p<0.001). Patients managed with tMCS were more likely to die from persistent shock (p<0.01), both cardiogenic (73.5% vs. 62.0%) and non-cardiogenic (6.1% vs. 2.9%).

CONCLUSIONS: Most deaths in CS are related to direct cardiovascular causes, particularly persistent CS. However, there is important heterogeneity across subgroups defined by preceding CA and use of tMCS.