Acute cardiac care & resuscitationCohort study
Admission respiratory support strategies amongst patients with cardiogenic shock
- cohort study
- multicentre, nationally representative database
- inverse probability of treatment weighting
Authors' conclusion
Direct IMV and NIV before IMV were associated with worse outcomes than NIV alone. Results for direct IMV compared to NIV before IMV were not consistent between analyses and support the urgent need for a prospective study of respiratory support strategies.
Study context
- Population
- Adults with cardiogenic shock (CS) who received non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV) on the first hospital daypatients with CS
- Participants
- 81,892 adults
- Exposure
- NIV-first approach compared to direct invasive mechanical ventilation
- NIV onlyn = 13.7%
- direct IMVn = 81.9%
- NIV before IMVn = 4.4%
- Outcome
- In-hospital mortality
Main finding
As reported in the abstract
Estimate (95% CI)P value
direct IMV vs NIV onlyhigher mortality with IMV; after adjustment
absolute risk difference 11.8%(10.4–13.3)
P < 0.001NIV before IMV vs NIV onlyhigher mortality with NIV before IMV; after adjustment
absolute risk difference 12.9%(10.6–15.1)
P < 0.001direct IMV vs NIV before IMVMortality did not differ
risk difference 1.0%(−1.0-3.0)
P = 0.279Observational data: associations, not effects.
Further findings
Sensitivity analyses including lactate and stratified by SCAI D shock
- higher mortality with NIV before IMV compared to direct IMV
Original publication
Admission respiratory support strategies amongst patients with cardiogenic shock. Eur Heart J Acute Cardiovasc Care. Published 28 July 2026. doi:10.1093/ehjacc/zuag103
Summarised from the published abstract; every number is checked against it