Misdiagnosis of heart attack (myocardial infarction) remains a common problem in medicine. When quickly and correctly identified, patient outcomes are frequently good: folks get the treatment they need and get back to living their normal lives. If the diagnosis is missed, however, patients may suffer devastating injury and/or death. Timely and properly treating patients involves a number of interventions, depending on the patient’s symptoms. A recent drug trial demonstrated that prompt mechanical ventilation is critical to better outcomes for patients with cardiogenic shock.

Cardiogenic shock is present in less than twenty percent of all acute heart attack cases, but is the leading cause of death for patients hospitalized for heart attack. Cardiogenic shock is when the heart is suddenly incapable of pumping enough blood to meet the body’s needs. The cause is often a combination of factors affecting the heart’s normal rhythm and contractility (strength to pump blood).

The paper was covered in a recent article on Medpage Today. The article noted that “there was a significant relationship between delay in mechanical ventilation from the time of MI onset and mortality.” Providing that prompt critical airway access helped prevent irreversible damage to the heart muscle. Several details of the timing and strategies need to be fleshed out for maximum benefit but the overall results of this trial were that, essentially, earlier is better.

The report continued by reporting that providing mechanical ventilation in these patients could provide them further benefit. The researchers found that delay in mechanical intervention correlated with a significantly higher 30-day mortality.

The report was limited by its size (less than 400 patients) and that it was the result of a larger, failed, drug trial. This will likely lead to further research on this intervention.

The key remains in the providers’ timely identifying a heart attack. Once treatment begins, the type of interventions necessary varies by the seriousness of each patient’s symptoms. But we are learning that providing a clear airway and mechanical ventilation is vital way to improve patient outcomes.