PiCCO-Guided hemodynamic monitoring in cardiogenic shock complicated by arrhythmias and acute pulmonary edema

Abstract

Introduction. Cardiogenic shock (CS) represents the most severe form of acute circulatory failure and is associated with high mortality. The prognostic role of cardiac arrhythmias and acute pulmonary edema (APE), as well as the potential role of advanced hemodynamic monitoring, remains incompletely understood. Materials and methods. This retrospective observational study included 105 medical records of patients with cardiogenic shock admitted between June 2016 and August 2018 to the Holy Trinity Municipal Clinical Hospital, Chișinău. Patients were divided into two groups according to the type of monitoring used during hospitalization: the PiCCO group (n = 52) and the standard ECHO group (n = 53). Clinical characteristics, arrhythmia subtype, presence of APE, and in-hospital mortality were recorded. Continuous variables were expressed as mean ± SD and compared using Student’s t-test, while categorical variables were analyzed using the χ² test or Fisher’s exact test. Statistical significance was set at p < 0.05. Results. Arrhythmias were present in 92.4% of patients, and AF/AFL was the most frequent arrhythmia (56.2%). Mortality did not significantly differ according to arrhythmia subtype (p > 0.05). APE was detected in 60.9% of patients and was associated with markedly higher mortality (75.0%). In-hospital mortality was lower in the PiCCO group than in the ECHO group (36.5% vs 62.3%, p = 0.0112), particularly among patients with arrhythmias and among those without cardiac arrest. Conclusions. The specific type of arrhythmia was not significantly associated with mortality in cardiogenic shock. APE represents a major marker of hemodynamic severity and was associated with significantly increased mortality, particularly in the presence of arrhythmias. Advanced hemodynamic monitoring using PiCCO was associated with lower observed mortality; however, baseline differences between groups limit causal interpretation. Further prospective randomized studies are warranted to validate these findings.