Apoorva Gangavelli, MD, MSc: No financial relationships to disclose
Background: Shock is defined as circulatory failure leading to hypoperfusion, including manifestation as altered mental status. Disturbances in consciousness in cardiac arrest are known to be associated with mortality. However, whether neurologic dysfunction is associated with outcomes in patients with shock and specifically cardiogenic shock has not been studied.
Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of tertiary CICUs in North America coordinated by the TIMI Study Group. During annual campaigns, each center contributes at least 2-mo of all consecutive medical cardiac intensive care unit (CICU) admissions. We used the CCCTN registry to assess the relationship of GCS to outcomes in CICU patients. This analysis included all admissions with an admission GCS. Admissions were stratified by GCS level (GCS 15, GCS 13-14, GCS 10-12, GCS 6-9, GCS < 6). We analyzed presenting characteristics and outcomes by GCS.
Outcome: Of the 26,076 admissions, 20,569 (78.9%) had a non-missing evaluable GCS 15, 2,287 (8.8%) had a GCS 13-14, 769 (2.9%) had a GCS 10-12, 841 (3.2%) had a GCS 6-9, 1610 (6.2%) had a GCS < 6. The mean age was 65.5, 63.5% were male, and 54.8% were White. Overall, the CICU and in-hospital mortality rates were 7.9% and 11.6% respectively. The rates of CICU mortality differ significantly between GCS 15, GCS 13-14, GCS 10-12, GCS 6-9, and GCS < 6 groups (3.1%, 11.5%, 19.4%, 21.9%, 50.9%, p= < 0.001). The rates of in-hospital mortality differ significantly between GCS 15, GCS 13-14, GCS 10-12, GCS 6-9, and GCS < 6 groups (5.9%, 18.5%, 26.4%, 28.9%, 58.3%, p= < 0.001).
Conclusion: Admissions to the CICU with lower GCS scores appear to have higher rates of both CICU and in-hospitality mortality.
