The effect of a new thinking guidance of OPACCUS for shock on the 30-day mortality: A multicenter, prospective, observational, cohort study

Objectives: The purpose of this study was to determine whether our new thinking guidance named OPACCUS (oxygen metabolism, perfusion, arterial tension, cardiac output, systemic congestion, unregulated host response and search for inciting illness event) with 7 questions you need to ask before shock therapy and evidences provided by critical ultrasound considering hemodynamics, the unregulated host response and inciting illness event would improve mortality in shock patients.

Design: A multicenter, prospective, observational cohort study.

Setting: Intensive care units of 20 hospitals in Southwest China.

Patients: Shock patients between October 2022 and February 2024 were divided into three groups, namely, the full-compliance group (n = 171), moderate-compliance group (n = 149) and low-compliance group (n = 220), according to the compliance rate with the OPACCUS guidance.

Interventions: Adoption of the OPACCUS guidance in every repeat assessment MEASUREMENTS AND MAIN RESULTS: Demographics, clinical information, hemodynamics parameters and critical care ultrasound evaluations were recorded. The primary outcome was all-cause mortality within 30 days. A total of 540 patients completed the study and were ultimately included in the analysis. After multivariate regression adjustment, the 30-day mortality of shock patients in the full-compliance group (21.05 %) was significantly lower than that in the low-compliance group (36.82 %) (HR=1.646*, RMST=-3.223*). Restricted mean survival time (RMST) univariate analysis showed that the higher the OPACCUS compliance rate was, the longer the survival time. ICU and hospital costs were lower in the full-compliance group than in the moderate-compliance group.

Conclusions: Compliance to the new OPACCUS guidance could improve 30-day mortality and reduce costs for shock patients.

Trial registration: ClinicalTrials.gov Identifier: ChiCTR2200061952. Registration date: 13/07/2022.