Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study

• Published in: BMJ open Vol. 15; no. 6; p. e099208
• Main Authors: Arabi, Abdulrahman, Al Suwaidi, Jassim, Daoulah, Amin, AlQahtani, Awad Abdulrazaq, Shahid, Zubair, Jamjoom, Ahmed, Elmahrouk, Ahmed, AlShehri, Mohammed, Panduranga, Prashanth, Al Rawahi, Abeer Said Mohamed, Livingston, Gladsy Selva, Mousa, Ala’a Al-deen Tayseer, Aloui, Hatem, Aldossari, Mubarak, Yousif, Nooraldaem, Noor, Husam, Rajan, Rajesh, Al Mahmeed, Wael, Khan, Hassan, Qutub, Mohammed, Arafat, Amr A, Kanbr, Omar, Almarghany, Alsayed, Kahin, Mokhtar, Abohasan, Abdulwali, Al Nasser, Faisal, Alzahrani, Badr, Aldossari, Alaa, Hassan, Taher, Alenezi, Abdullah, Alharbi, Waleed, Balghith, Mohammed Ali, Alobaikan, Sultan, Alshali, Khalid, Lotfi, Amir
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 04.06.2025; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Aged; Angioplasty; Blood pressure; Body mass index; Cardiac arrest; Cardiopulmonary resuscitation; Cardiovascular Medicine; Clinical outcomes; Coronary intervention; Coronary vessels; CPR; Edema; Female; Heart attacks; Heart rate; Hospital Mortality; Humans; Intubation; Ischaemic heart disease; Ischemia; Male; Middle Aged; Middle East - epidemiology; Mortality; Myocardial infarction; Observational studies; Original Research; Registries; Respiration, Artificial - methods; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; Time Factors; Time-to-Treatment; Treatment Outcome; Variables; Veins & arteries; Ventilation; Ventilators, Mechanical; Middle East; Myocardial infarction; Ventilators, Mechanical; Coronary intervention; Ischaemic heart disease; Mortality
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2025-099208

ObjectiveTo evaluate the association between the timing of invasive mechanical ventilation (MV) initiation and clinical outcomes in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI).DesignRetrospective analysis of a multicentre registry.SettingData were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.Participants1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.Primary and secondary outcome measuresThe primary outcome was in-hospital mortality. Secondary outcomes included comparisons of baseline characteristics, Society of Coronary Angiogram and Intervention (SCAI) shock stage, and clinical parameters among groups based on time to MV.ResultsParticipants were categorised by time from shock diagnosis to MV: early (≤15 min), intermediate (30 min) and late (≥60 min). Median times were 15 min (IQR 10–20), 30 min (IQR 25–35) and 60 min (IQR 45–70), respectively. Baseline characteristics were comparable across groups. Increased delay in MV was associated with a higher mortality risk during the first 60 min post-diagnosis, beyond which the risk plateaued. Delayed MV was an independent predictor of in-hospital mortality (OR 2.14, 95% CI 1.36 to 3.38, p<0.001).ConclusionsEarly initiation of MV in patients with STEMI complicated by CS was associated with lower in-hospital mortality. These findings highlight the importance of timely respiratory support, warranting further investigation in prospective or randomised controlled studies.