Efficacy of Non-invasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis

Abstract

Background: Cardiogenic shock has a high mortality rate, and ventilation support is commonly required. Non-invasive ventilation (NIV) provides several advantages over invasive mechanical ventilation (IMV) and is safe in cardiogenic pulmonary edema. However, its efficacy in cardiogenic shock remains unclear. This study aimed to evaluate the efficacy and safety of NIV compared to IMV in this population. Data sources: A systematic search was conducted across four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to February 12, 2025, without language restrictions. Study selection: Studies were included if they compared NIV vs IMV in patients diagnosed with cardiogenic shock and reported relevant clinical outcomes. Data extraction: Two reviewers independently extracted data on study characteristics, patient demographics, and outcomes. Risk of bias was independently assessed using appropriate tools for the included studies. Data synthesis: A total of 6 observational, non-randomized studies involving 2,302 participants were included in this meta-analysis, using a random-effects model. Non-invasive ventilation was associated with a significantly lower risk of in-hospital mortality [odds ratio (OR) 0.55 (95% confidence interval (CI): 0.38-0.79), p < 0.01; I² = 35.85%] and 30-day mortality (OR: 0.47 (95% CI: 0.35-0.63), p < 0.01; I² = 0%) compared to IMV. Non-invasive ventilation also reduced the length of hospital stays and intensive care unit/coronary care unit stays. Sensitivity analyses, including two studies using propensity score adjustment, showed the consistent benefit of NIV in reducing in-hospital mortality and length of hospital stay. Conclusions: Non-invasive ventilation was associated with improved short-term outcomes compared with IMV in carefully selected patients with cardiogenic shock. However, all included studies were observational, with potential for residual confounding; therefore, further randomized studies are warranted.