Profile and Outcomes of Patients Presenting With Sympathetic Crashing Acute Pulmonary Edema (SCAPE) to a Tertiary Care Emergency Department in North India: A Prospective Observational Study.

Background: Sympathetic crashing acute pulmonary edema (SCAPE) is a severe manifestation of acute heart failure, characterized by sudden pulmonary edema due to elevated sympathetic activity. Objective: This study aimed to describe the clinical profile, management, and short-term outcomes of patients with SCAPE presenting to a tertiary care hospital in North India. Methods: This prospective observational study described the clinical profile of patients with SCAPE who were managed with high-dose nitroglycerin (NTG). Results: Sixty-two patients with a mean age of 49.4 years were enrolled, and 90.3% had one or more comorbidities. All patients exhibited signs of sympathetic excess and pulmonary edema on point-of-care ultrasound (POCUS). The treatment protocol included high-dose NTG and non-invasive ventilation (NIV). Male sex, chronic kidney disease, longer symptom duration, plethoric inferior vena cava on POCUS, higher initial lactate, and the need for hemodialysis were identified as predictors of poor outcomes in the univariate analysis. Conclusions: This study highlights that a protocol-based approach using high-dose NTG and NIV in managing SCAPE patients shows a favorable outcome, resulting in low rates of mechanical ventilation and mortality despite high comorbidity burden and ICU admission rates.