title: The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock.
abstract: OBJECTIVE
  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 >6 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 >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.
  
  
  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.
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Muller
authors.affiliation: Thoracic and Cardio-Vascular Surgery Department, Centre Cardio-Pneumologique, Hôpital Universitaire Pontchaillou, 2, rue Henri-Le-Guilloux, 35000, Rennes Cedex, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flecher
authors.affiliation: Cardiac Surgery Department, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Cardiac Surgery Department, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Ciro
authors.initials: C
authors.lastname: Mastroianni
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: Cardiac Surgery Department, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Thoracic and Cardio-Vascular Surgery Department, Centre Cardio-Pneumologique, Hôpital Universitaire Pontchaillou, 2, rue Henri-Le-Guilloux, 35000, Rennes Cedex, France.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.affiliation: Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France. alain.combes@aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D011788:Quality of Life; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology
keywords: Acute myocardial infarction; Cardiogenic shock; Extracorporeal membrane oxygenation; Long-term quality of life; Outcome assessment
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