Impact of a cardiac intensivist on mortality in patients with cardiogenic shock

Background This study aimed to evaluate the association between high-intensity staffing by a dedicated cardiac intensivist and clinical outcomes in CS. Methods We enrolled 2923 consecutive patients admitted to a cardiac care unit (CCU) from January 1, 2012 to December 31, 2015. In January 2013, the CCU changed from a low-intensity to high-intensity staffing unit managed by a dedicated cardiac intensivist. Patients were eligible if they required inotropes or vasopressors to maintain a systolic blood pressure > 90 mm Hg, and had serum lactate ≥ 2.0 mmol/L. Eligible patients (n = 513) were treated by low-intensity CCU (n = 352) or high-intensity CCU (n = 161). The primary outcome was CCU mortality. Results CCU mortality occurred in 49 patients (30.6%) of the low-intensity group versus 62 patients (17.6%) of the high-intensity group (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.25–0.75, p < 0.001). In-hospital mortality was not significantly different between the groups (33.1% vs 24.4%, aOR 0.75, 95% CI 0.43–1.29, p = 0.29). Among 135 patients treated with extracorporeal membrane oxygenation, the high-intensity model was associated with lower CCU mortality (54.5% vs 22.5%, aOR 0.24, 95% CI 0.07–0.77, p = 0.02) and in-hospital mortality (57.6% vs 29.4%, aOR 0.28, 95% CI 0.10–0.81, p = 0.02). Conclusion High-intensity staffed CCU managed by a dedicated cardiac intensivist was associated with a significant reduction of CS-related mortality.