Clinical Impact of Initial Fluid Resuscitation in Patients With Cardiogenic Shock

To assess the current status of initial fluid administration in patients with cardiogenic shock.

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.

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.

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.