Assessing the Clinical Impact of Cardiac Intensivists in Cardiac Intensive Care Units.: Results from the RESCUE registry

Author:

Bae Dae-Hwan1,Lee Sang Yeub2,Bae Jang-Whan1,Yang Jeong Hoon3,Ko Young-Guk4,Ahn Chul-Min4,Yu Cheol Woong5,Chun Woo Jung6,Kim Hyun-Joong7,Kim Bum Sung7,Kwon Sung Uk8,Kim Je Sang9,Lee Wang Soo10,Jang Woo Jin10,Jeong Jin-Ok11,Park Sang-Don12,Lim Seong-Hoon13,Cho Sungsoo14,Gwon Hyeon-Cheol3

Affiliation:

1. Chungbuk National University Hospital

2. Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital

3. Samsung Medical Center, Sungkyunkwan University School of Medicine

4. Yonsei University College of Medicine

5. Korea University Anam Hospital

6. Samsung Changwon Hospital, Sungkyunkwan University School of Medicine

7. Konkuk University Medical Center

8. University of Inje College of Medicine

9. Sejong General Hospital

10. Chung-Ang University Hospital

11. Chungnam National University Hospital

12. Inha University Hospital

13. Dankook University Hospital, Dankook University College of Medicine

14. Gangnam Severance Hospital

Abstract

Abstract

Background The presence of dedicated intensive care unit (ICU) physicians is associated with reduced ICU mortality. However, the information available on the role of cardiac intensivists in cardiac ICUs (CICUs) is limited. Therefore, we investigated the association of cardiac intensivist–directed care with clinical outcomes in adult patients admitted to the CICU. Methods In this retrospective study, we extracted data from the SMART-RESCUE registry, a multicenter, retrospective, and prospective registry of patients presenting with cardiogenic shock. Overall, 1,247 patients with CS were enrolled, between January 2014 and December 2018, from 12 tertiary centers in Korea. The patients were categorized into two groups based on the involvement of a cardiac intensivist in their care. The primary outcome was in-hospital mortality rate. Results The all-cause mortality rate was 33.6%. The in-hospital mortality rate was lower (25.4%) in the cardiac intensivist group than in the non-cardiac intensivist group (40.1%). Cardiac mortality rates were 20.5% and 35.4% in the cardiac intensivist and non-cardiac intensivist groups, respectively. In patients undergoing extracorporeal membrane oxygenation, the mortality rate at centers with cardiac intensivists was 38.0%, whereas that at centers without cardiac intensivists was 62.2%. The dopamine use was lower, norepinephrine use was higher, and vasoactive-inotropic score was lower in the cardiac intensivist group than in the non-cardiac intensivist group. Conclusions Involvement of a cardiac intensivist in CICU patient care was associated with a reduction in in-hospital mortality rate and the administration of a low dose of vasopressors and inotropes according to the cardiogenic shock guidelines.

Publisher

Springer Science and Business Media LLC

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