Key result
IMV in cardiogenic shock linked to ~5.3-fold higher odds of in-hospital mortality.
Why the study?
Invasive mechanical ventilation (IMV) is frequently required in patients with cardiogenic shock (CS) and haemodynamic instability, but its association with in-hospital mortality in contemporary national cohorts was not well characterised.
Is invasive mechanical ventilation associated with increased in-hospital mortality in adults hospitalized with cardiogenic shock?
Observational (n=215,830)
Yes
Is invasive mechanical ventilation associated with increased in-hospital mortality in adults hospitalized with cardiogenic shock?
In a nationally representative US cohort of cardiogenic shock hospitalizations, the requirement for invasive mechanical ventilation was independently associated with more than five-fold higher odds of in-hospital mortality.
IMV requirement identifies high-mortality cardiogenic shock subsets; leaves open whether ventilation itself drives excess risk or merely reflects severity.
Background/Introduction Cardiogenic shock (CS) remains associated with high in-hospital mortality. Invasive mechanical ventilation (IMV) is frequently required in patients with haemodynamic instability; however, its association with mortality in contemporary national cohorts is not well characterised. Purpose To evaluate the association between IMV use and in-hospital mortality among hospitalisations with CS in the United States. Methods We performed a retrospective analysis of the 2021 Nationwide Inpatient Sample. Adult hospitalisations with cardiogenic shock were identified using validated administrative coding. Survey weights were applied to generate national estimates. Weighted mortality rates were calculated using survey-adjusted methods. Multivariable logistic regression accounting for survey design was performed to assess the association between IMV and in-hospital mortality, adjusting for age, sex, race, primary payer, median income quartile, hospital teaching status and hospital region. Results A weighted total of 215,830 hospitalisations with CS were identified. IMV was used in 95,525 (44.3%) cases. In-hospital mortality was significantly higher in patients receiving IMV compared with those not receiving IMV (52.0% vs 18.6%, p<0.001). In unadjusted analysis, IMV was associated with increased odds of mortality. After multivariable adjustment, IMV remained independently associated with in-hospital mortality (adjusted OR 5.26, 95% CI 5.03–5.51; p<0.001). Conclusion(s) In a contemporary nationally representative cohort, IMV use in cardiogenic shock was strongly associated with increased in-hospital mortality, even after adjustment for patient and hospital characteristics. These findings highlight the severe risk profile of mechanically ventilated patients with CS and underscore the need for strategies aimed at earlier intervention and optimisation of respiratory and haemodynamic support.
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Levy et al. (2026) conducted an observational in Cardiogenic shock (n=215,830). Invasive mechanical ventilation (IMV) vs. No invasive mechanical ventilation was evaluated on In-hospital mortality (adjusted OR 5.26, 95% CI 5.03-5.51, p=<0.001). Invasive mechanical ventilation in cardiogenic shock was associated with higher in-hospital mortality vs no IMV (52.0% vs 18.6%; adjusted OR 5.26, 95% CI 5.03-5.51; p<0.001).
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