Invasive hemodynamic monitoring-guided resuscitation improves survival in shock: A systematic review and meta-analysis.

Background: Mortality in shock may reach 60%; hence, immediate, adequate resuscitation has a crucial role in improving outcomes. Detailed hemodynamic monitoring is desirable, but evidence on its outcome benefits is limited. Therefore, this study aimed to compare advanced hemodynamic monitoring (AHDM)-guided clinical decision-making and treatment with conventional ones in terms of outcomes in shock. Methods: A systematic search was performed in three databases (PubMed, EMBASE, and Cochrane Library) until 9 November 2024. Randomised controlled trials, non-randomised and observational studies involving adult shock patients were eligible for inclusion. Main outcomes were in-hospital and 30-day mortality, and secondary outcomes included length of stay, need for and duration of organ support, and amount of fluid administered. Meta-analyses were performed using a random-effects model, with heterogeneity and risk of bias assessed. The review protocol was registered in PROSPERO (ID: CRD42024607758). Results: A total of 34 studies, including seven RCTs and 636,441 shock patients, were analysed to compare AHDM with conventional monitoring. The use of any type of AHDM was associated with a significantly lower in-hospital mortality for any type of shock (OR: 0.66; 95% CI: [0.48; 0.91], Conclusion: AHDM use is associated with a significant reduction in mortality in shock patients, with the greatest benefit observed in cardiogenic shock. The observed outcomes suggest that AHDM may facilitate qualitative changes in decision-making, consistent with precision-guided resuscitation.