Abstract 4348886: The Safety of Non-invasive Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis

Background: Cardiogenic shock is associated with high mortality and usually requires ventilatory support. Non-invasive ventilation (NIV) has demonstrated benefits in cardiogenic pulmonary edema, including reduced risk of infection and shorter hospital stays compared to invasive mechanical ventilation (IMV). However, the efficacy and safety of NIV specifically in cardiogenic shock remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of NIV compared to IMV in patients with cardiogenic shock. Methods: A systematic search was conducted across 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to February 12, 2025, without language restrictions. Studies were included if they compared the efficacy and safety of NIV and IMV in patients with cardiogenic shock. Results: A total of 6 studies involving 2,302 participants were included in this meta-analysis, using a random-effects model. NIV was associated with a significantly lower risk of in-hospital mortality compared to IMV, with a risk ratio (RR) of 0.70 (95%CI 0.52 to 0.94), p=0.02. NIV was also associated with a lower risk of 30-day all-cause mortality, with an RR of 0.63 (95%CI 0.51 to 0.77), p<0.01. NIV was associated with a shorter length of ICU/CCU stay (weighted mean difference (WMD) of -2.06 days; 95%CI -2.76 to -1.37; p<0.01) and hospital stay (WMD of -3.20 days; 95%CI -5.33 to -1.07; p<0.01) compared to IMV. Conclusions: NIV appears to be an effective and safe alternative to IMV in carefully selected patients with cardiogenic shock.