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- Title
The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock.
- Authors
Muller, Grégoire; Flecher, Erwan; Lebreton, Guillaume; Luyt, Charles-Edouard; Trouillet, Jean-Louis; Bréchot, Nicolas; Schmidt, Matthieu; Mastroianni, Ciro; Chastre, Jean; Leprince, Pascal; Anselmi, Amedeo; Combes, Alain
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>Data from 138 ECMO-treated AMI patients admitted to two French ICUs (2008-2013) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQOL, psychological and PTSD status.<bold>Results: </bold>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 >60, female sex, body mass index >25 kg/m(2), Glasgow coma score <6, creatinine >150 μmol/L, lactate (<2, 2-8, or >8 mmol/L), and prothrombin activity <50%. 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.<bold>Conclusions: </bold>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.
- Subjects
FRANCE; HEALTH outcome assessment; MORTALITY risk factors; OXYGENATION (Chemistry); MYOCARDIAL infarction treatment; QUALITY of life; MYOCARDIAL infarction-related mortality; ANXIETY; CARDIOGENIC shock; COMPARATIVE studies; MENTAL depression; EXTRACORPOREAL membrane oxygenation; INTENSIVE care units; RESEARCH methodology; MEDICAL cooperation; POST-traumatic stress disorder; QUESTIONNAIRES; RESEARCH; RISK assessment; EVALUATION research; PREDICTIVE tests; GLASGOW Coma Scale; THERAPEUTICS
- Publication
Intensive Care Medicine, 2016, Vol 42, Issue 3, p370
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-016-4223-9