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The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock

Abstract : PURPOSE: This study was designed to identify factors associated with in-intensive care unit (ICU) death and develop a practical mortality risk score for venoarterial-extracorporeal membrane oxygenation (VA-ECMO)-treated acute myocardial infarction (AMI) patients. Long-term survivors' health-related quality of life (HRQOL), anxiety, depression, and post-traumatic stress disorder (PTSD) frequencies were also assessed. METHODS: Data from 138 ECMO-treated AMI patients admitted to two French ICUs (2008-2013) were analyzed. ICU survivors contacted \textgreater6 months post-ICU discharge were assessed for HRQOL, psychological and PTSD status. RESULTS: Sixty-five patients (47 %) survived to ICU discharge. On the basis of multivariable logistic regression analyses, the ENCOURAGE score was constructed with seven pre-ECMO parameters: age \textgreater60, female sex, body mass index \textgreater25 kg/m(2), Glasgow coma score \textless6, creatinine \textgreater150 μmol/L, lactate (\textless2, 2-8, or \textgreater8 mmol/L), and prothrombin activity \textless50 %. Six months after ECMO, probabilities of survival were 80, 58, 25, 20, and 7 % for ENCOURAGE score classes 0-12, 13-18, 19-22, 23-27, and ≥28, respectively. The ENCOURAGE score ROC AUC [0.84 (95 % CI 0.77-0.91)] was significantly better than those of the SAVE, SAPS II, and SOFA scores. Survivors' HRQOL evaluated after median follow-up of 32 months revealed satisfactory mental health but persistent physical and emotional-related difficulties, with 34 % (95 % CI 20-49 %) anxiety, 20 % (95 % CI 8-32 %) depression, and 5 % (95 % CI 0-12 %) PTSD symptoms reported. CONCLUSIONS: The ENCOURAGE score might be a useful tool to predict mortality of severe cardiogenic shock AMI patients who received VA-ECMO. However, it now needs prospective validation on other populations of AMI patients
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01274303
Contributor : Laurent Jonchère <>
Submitted on : Monday, February 15, 2016 - 4:49:23 PM
Last modification on : Tuesday, October 20, 2020 - 10:51:05 AM

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Grégoire Muller, Erwan Flécher, Guillaume Lebreton, Charles-Edouard Luyt, Jean-Louis Trouillet, et al.. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Medicine, Springer Verlag, 2016, 42 (3), pp.370-8. ⟨10.1007/s00134-016-4223-9⟩. ⟨hal-01274303⟩

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