Grégoire Muller1, Erwan Flecher2, Guillaume Lebreton3, Charles-Edouard Luyt1, Jean-Louis Trouillet1, Nicolas Bréchot1, Matthieu Schmidt1, Ciro Mastroianni3, Jean Chastre1, Pascal Leprince3, Amedeo Anselmi2, Alain Combes4. 1. 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. 2. Thoracic and Cardio-Vascular Surgery Department, Centre Cardio-Pneumologique, Hôpital Universitaire Pontchaillou, 2, rue Henri-Le-Guilloux, 35000, Rennes Cedex, France. 3. 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. 4. 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.
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 >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.
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 >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 AMIpatients who received VA-ECMO. However, it now needs prospective validation on other populations of AMI patients.
Authors: Lynn A Sleeper; Krishnan Ramanathan; Michael H Picard; Thierry H Lejemtel; Harvey D White; Vladimir Dzavik; Deborah Tormey; Nancy E Avis; Judith S Hochman Journal: J Am Coll Cardiol Date: 2005-07-19 Impact factor: 24.094
Authors: Donald Edmondson; Safiya Richardson; Louise Falzon; Karina W Davidson; Mary Alice Mills; Yuval Neria Journal: PLoS One Date: 2012-06-20 Impact factor: 3.240
Authors: Alain Combes; Dan Brodie; Yih-Sharng Chen; Eddy Fan; José P S Henriques; Carol Hodgson; Philipp M Lepper; Pascal Leprince; Kunihiko Maekawa; Thomas Muller; Sebastian Nuding; Dagmar M Ouweneel; Antoine Roch; Matthieu Schmidt; Hiroo Takayama; Alain Vuylsteke; Karl Werdan; Laurent Papazian Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440