Log in | Register

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

Grégoire Muller| Erwan Flecher| Guillaume Lebreton| Charles-Edouard Luyt| Jean-Louis Trouillet| Nicolas Bréchot| Matthieu Schmidt| Ciro Mastroianni| Jean Chastre| Pascal Leprince| Amedeo Anselmi| Alain Combes
Original
Volume 42, Issue 3 / March , 2016

Pages 370 - 378

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/m2, 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.

Keywords

References

  1. Thiele H, Ohman EM, Desch S, Eitel I, de Waha S (2015) Management of cardiogenic shock. Eur Heart J 36:1223–1230
    • View reference on publisher's website
    • View reference on PubMed
  2. Abrams D, Combes A, Brodie D (2014) Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol 63:2769–2778
    • View reference on publisher's website
    • View reference on PubMed
  3. Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411
    • View reference on publisher's website
    • View reference on PubMed
  4. Petroni T, Harrois A, Amour J, Lebreton G, Brechot N, Tanaka S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Duranteau J, Combes A (2014) Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Crit Care Med 42:2075–2082
    • View reference on publisher's website
    • View reference on PubMed
  5. Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, Pavie A, Chastre J, Combes A (2013) Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med 41:1616–1626
    • View reference on publisher's website
    • View reference on PubMed
  6. Schmidt M, Brechot N, Hariri S, Guiguet M, Luyt CE, Makri R, Leprince P, Trouillet JL, Pavie A, Chastre J, Combes A (2012) Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 55:1633–1641
    • View reference on publisher's website
    • View reference on PubMed
  7. Mirabel M, Luyt CE, Leprince P, Trouillet JL, Leger P, Pavie A, Chastre J, Combes A (2011) Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 39:1029–1035
    • View reference on publisher's website
    • View reference on PubMed
  8. Doll N, Kiaii B, Borger M, Bucerius J, Kramer K, Schmitt DV, Walther T, Mohr FW (2004) Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 77:151–157 (discussion 157)
    • View reference on publisher's website
    • View reference on PubMed
  9. Kim H, Lim SH, Hong J, Hong YS, Lee CJ, Jung JH, Yu S (2012) Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock. Resuscitation 83:971–975
    • View reference on publisher's website
    • View reference on PubMed
  10. Sheu JJ, Tsai TH, Lee FY, Fang HY, Sun CK, Leu S, Yang CH, Chen SM, Hang CL, Hsieh YK, Chen CJ, Wu CJ, Yip HK (2010) Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med 38:1810–1817
    • View reference on publisher's website
    • View reference on PubMed
  11. Schmidt M, Brechot N, Combes A (2015) Ten situations in which ECMO is unlikely to be successful. Intensive Care Med. doi:10.1007/s00134-015-4013-9
  12. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619
    • View reference on publisher's website
    • View reference on PubMed
  13. Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS (2005) Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294:448–454
    • View reference on publisher's website
    • View reference on PubMed
  14. Klein LW, Shaw RE, Krone RJ, Brindis RG, Anderson HV, Block PC, McKay CR, Hewitt K, Weintraub WS (2005) Mortality after emergent percutaneous coronary intervention in cardiogenic shock secondary to acute myocardial infarction and usefulness of a mortality prediction model. Am J Cardiol 96:35–41
    • View reference on publisher's website
    • View reference on PubMed
  15. Sleeper LA, Reynolds HR, White HD, Webb JG, Dzavik V, Hochman JS (2010) A severity scoring system for risk assessment of patients with cardiogenic shock: a report from the SHOCK Trial and Registry. Am Heart J 160:443–450
    • View reference on publisher's website
    • View reference on PubMed
  16. Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus KL (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Eur Heart J 25:322–328
    • View reference on publisher's website
    • View reference on PubMed
  17. Alexander JH, Reynolds HR, Stebbins AL, Dzavik V, Harrington RA, Van de Werf F, Hochman JS (2007) Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 297:1657–1666
    • View reference on publisher's website
    • View reference on PubMed
  18. Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P, Col J, White HD (2006) Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 295:2511–2515
    • View reference on publisher's website
    • View reference on PubMed
  19. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Bohm M, Ebelt H, Schneider S, Schuler G, Werdan K (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296
    • View reference on publisher's website
    • View reference on PubMed
  20. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, Brodie D, Pellegrino V, Pilcher D (2015) Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 36:2246–2256
    • View reference on publisher's website
    • View reference on PubMed
  21. Leplege A, Ecosse E, Verdier A, Perneger TV (1998) The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51:1013–1023
    • View reference on publisher's website
    • View reference on PubMed
  22. Trouillet JL, Luyt CE, Guiguet M, Ouattara A, Vaissier E, Makri R, Nieszkowska A, Leprince P, Pavie A, Chastre J, Combes A (2011) Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med 154:373–383
    • View reference on publisher's website
    • View reference on PubMed
  23. Schmidt M, Zogheib E, Roze H, Repesse X, Lebreton G, Luyt CE, Trouillet JL, Brechot N, Nieszkowska A, Dupont H, Ouattara A, Leprince P, Chastre J, Combes A (2013) The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39:1704–1713
  24. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
    • View reference on publisher's website
    • View reference on PubMed
  25. Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218
    • View reference on publisher's website
    • View reference on PubMed
  26. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on publisher's website
    • View reference on PubMed
  27. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
  28. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345–2353
    • View reference on publisher's website
    • View reference on PubMed
  29. Cheng JM, Helming AM, van Vark LC, Kardys I, Den Uil CA, Jewbali LS, van Geuns RJ, Zijlstra F, van Domburg RT, Boersma E, Akkerhuis KM (2015) A simple risk chart for initial risk assessment of 30-day mortality in patients with cardiogenic shock from ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. doi:10.1177/2048872615568966
  30. Sleeper LA, Ramanathan K, Picard MH, Lejemtel TH, White HD, Dzavik V, Tormey D, Avis NE, Hochman JS (2005) Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 46:266–273
    • View reference on publisher's website
    • View reference on PubMed
  31. Sanborn TA, Sleeper LA, Webb JG, French JK, Bergman G, Parikh M, Wong SC, Boland J, Pfisterer M, Slater JN, Sharma S, Hochman JS (2003) Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 42:1373–1379
    • View reference on publisher's website
    • View reference on PubMed
  32. Distelmaier K, Winter MP, Rutzler K, Heinz G, Lang IM, Maurer G, Koinig H, Steinlechner B, Niessner A, Goliasch G (2014) Serum butyrylcholinesterase predicts survival after extracorporeal membrane oxygenation after cardiovascular surgery. Crit Care 18:R24
    • View reference on publisher's website
    • View reference on PubMed
  33. Kagawa E, Dote K, Kato M, Sasaki S, Nakano Y, Kajikawa M, Higashi A, Itakura K, Sera A, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S (2012) Should we emergently revascularize occluded coronaries for cardiac arrest?: rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation 126:1605–1613
    • View reference on publisher's website
    • View reference on PubMed
  34. Beurtheret S, Mordant P, Paoletti X, Marijon E, Celermajer DS, Leger P, Pavie A, Combes A, Leprince P (2013) Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program). Eur Heart J 34:112–120
    • View reference on publisher's website
    • View reference on PubMed
  35. Ostenfeld S, Lindholm MG, Kjaergaard J, Bro-Jeppesen J, Moller JE, Wanscher M, Hassager C (2014) Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction. Resuscitation 87C:57–62
  36. Brown N, Melville M, Gray D, Young T, Munro J, Skene AM, Hampton JR (1999) Quality of life four years after acute myocardial infarction: short form 36 scores compared with a normal population. Heart 81:352–358
    • View reference on publisher's website
    • View reference on PubMed
  37. Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA (2005) Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). J Am Coll Cardiol 45:221–228
    • View reference on publisher's website
    • View reference on PubMed
  38. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Bohm M, Ebelt H, Schneider S, Werdan K, Schuler G (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382:1638–1645
    • View reference on publisher's website
    • View reference on PubMed
  39. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304
    • View reference on publisher's website
    • View reference on PubMed
  40. Martin CR, Lewin RJ, Thompson DR (2003) A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Res 120:85–94
    • View reference on publisher's website
    • View reference on PubMed
  41. Ameratunga S, Tin Tin S, Coverdale J, Connor J, Norton R (2009) Posttraumatic stress among hospitalized and nonhospitalized survivors of serious car crashes: a population-based study. Psychiatr Serv 60:402–404
    • View reference on publisher's website
    • View reference on PubMed
  42. Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y (2012) Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLoS One 7:e38915
    • View reference on publisher's website
    • View reference on PubMed
  43. Dickens CM, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed FH (2006) Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction. Br J Psychiatry J Mental Sci 189:367–372
    • View reference on publisher's website
  44. Luyt CE, Landivier A, Leprince P, Bernard M, Pavie A, Chastre J, Combes A (2012) Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care 27(524):e7–e14
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement