Propofol vs etomidate for induction prior to invasive mechanical ventilation in patients with acute myocardial infarction.
Acute myocardial infarction
Cardiogenic shock
Invasive mechanical ventilation
Rapid sequence intubation
Journal
American heart journal
ISSN: 1097-6744
Titre abrégé: Am Heart J
Pays: United States
ID NLM: 0370465
Informations de publication
Date de publication:
28 Mar 2024
28 Mar 2024
Historique:
received:
11
01
2024
revised:
19
03
2024
accepted:
21
03
2024
medline:
31
3
2024
pubmed:
31
3
2024
entrez:
30
3
2024
Statut:
aheadofprint
Résumé
Patients with acute myocardial infarction (AMI) requiring invasive mechanical ventilation (IMV) have a high mortality. However, little is known regarding the impact of induction agents, used prior to IMV, on clinical outcomes in this population. We assessed for the association between induction agent and mortality in patients with AMI requiring IMV. We compared clinical outcomes between those receiving propofol compared to etomidate for induction among adults with AMI between October 2015 and December 2019 using the Vizient® Clinical Data Base, a multicenter, US national database. We used inverse probability treatment weighting (IPTW) to assess for the association between induction agent and in-hospital mortality. We identified 5,147 patients, 1,386 (26.9%) of received propofol and 3,761 (73.1%) received etomidate for IMV induction. The mean (SD) age was 66.1 (12.4) years, 33.0% were women, and 51.6% and 39.8% presented with STEMI and cardiogenic shock, respectively. Patients in the propofol group were more likely to require pre-intubation vasoactive medication and mechanical circulatory support (both, P<0.05). Utilization of propofol was associated with lower mortality compared to etomidate (32.3 vs. 36.1%, P=0.01). After propensity weighting, propofol use remained associated with lower mortality (weighted mean difference -4.7%; 95% Confidence interval: -7.6% to -1.8%, P=0.002). Total cost, ventilator days, and length of stay were higher in the propofol group (all, P<0.001). Induction with propofol, compared with etomidate, was associated with lower mortality for patients with AMI requiring IMV. Randomized trials are needed to determine the optimal induction agent for this critically ill patient population.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with acute myocardial infarction (AMI) requiring invasive mechanical ventilation (IMV) have a high mortality. However, little is known regarding the impact of induction agents, used prior to IMV, on clinical outcomes in this population. We assessed for the association between induction agent and mortality in patients with AMI requiring IMV.
METHODS
METHODS
We compared clinical outcomes between those receiving propofol compared to etomidate for induction among adults with AMI between October 2015 and December 2019 using the Vizient® Clinical Data Base, a multicenter, US national database. We used inverse probability treatment weighting (IPTW) to assess for the association between induction agent and in-hospital mortality.
RESULTS
RESULTS
We identified 5,147 patients, 1,386 (26.9%) of received propofol and 3,761 (73.1%) received etomidate for IMV induction. The mean (SD) age was 66.1 (12.4) years, 33.0% were women, and 51.6% and 39.8% presented with STEMI and cardiogenic shock, respectively. Patients in the propofol group were more likely to require pre-intubation vasoactive medication and mechanical circulatory support (both, P<0.05). Utilization of propofol was associated with lower mortality compared to etomidate (32.3 vs. 36.1%, P=0.01). After propensity weighting, propofol use remained associated with lower mortality (weighted mean difference -4.7%; 95% Confidence interval: -7.6% to -1.8%, P=0.002). Total cost, ventilator days, and length of stay were higher in the propofol group (all, P<0.001).
CONCLUSIONS
CONCLUSIONS
Induction with propofol, compared with etomidate, was associated with lower mortality for patients with AMI requiring IMV. Randomized trials are needed to determine the optimal induction agent for this critically ill patient population.
Identifiants
pubmed: 38554762
pii: S0002-8703(24)00074-7
doi: 10.1016/j.ahj.2024.03.013
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None