Clinical Impact of Initial Fluid Resuscitation in Patients With Cardiogenic Shock

Aim: To assess the current status of initial fluid administration in patients with cardiogenic shock. Methods: Patients with cardiogenic shock registered in the Japanese Circulation Society Cardiovascular Shock Registry were analyzed to investigate real-world fluid resuscitation status upon hospital arrival. From this registry, patients with and without pulmonary congestion were investigated to identify differences in fluid administration. Additionally, the 30-day mortality rate between the groups was examined on the basis of the initial fluid volume administered. Results: A total of 586 patients with cardiogenic shock were included. Initial fluid resuscitation within 30 min after hospital arrival was administered to 568 (96.9%) patients. In multivariate logistic regression for 30-day mortality, older age, lower systolic blood pressure, and a fluid volume of 1001-2000 mL within 30 min after hospital arrival were significant predictors. The 30-day mortality rate in patients with pulmonary congestion (442 patients) was higher than that in patients without pulmonary congestion (144 patients). However, there was no difference in the 30-day mortality rate between the groups based on the initial fluid volume administered. Conclusion: Initial fluid administration in patients with cardiogenic shock is common practice. Although patients with pulmonary congestion had higher overall 30-day mortality, the volume of initial fluid administered after hospital arrival was not associated with worse 30-day mortality.