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

Muller, Grégoire; Flécher, Erwan; Lebreton, Guillaume; Luyt, Charles‐Édouard; Trouillet, Jean‐Louis; Bréchot, Nicolas; Schmidt, Matthieu; Mastroianni, Ciro; Chastre, Jean; Leprince, Pascal; Anselmi, Amédéo; Combes, Alain

doi:10.1007/s00134-016-4223-9

Cited by 375 publications

(339 citation statements)

References 47 publications

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“…Although data to support the combination of venoarterial (VA)-extracorporeal membrane oxygenation (ECMO) and left ventricular unloading device (e.g., Impella ® ) are scarce, with variable outcome to date, we fully agree this strategy could be discussed as a bridge to recovery, bridge to another mechanical device or to heart transplantation. However, in the study cited reporting 40 % of survival, only three patients received an Impella ® in addition to ECMO, and none had premorbid aortic regurgitation [3]. In our opinion, refractory cardiogenic shock associated with severe aortic regurgitation should require immediate aortic valve surgery.…”

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confidence: 74%

Four situations in which ECMO might have a chance: response to Staudacher et al.

Schmidt

Bréchot

2016

Intensive Care Med

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Dear Editor, We thank Staudacher et al. for their interest [1] in our brief article entitled "Ten situations in which ECMO is unlikely to be successful" [2]. Although data to support the combination of venoarterial (VA)-extracorporeal membrane oxygenation (ECMO) and left ventricular unloading device (e.g., Impella ® ) are scarce, with variable outcome to date, we fully agree this strategy could be discussed as a bridge to recovery, bridge to another mechanical device or to heart transplantation. However, in the study cited reporting 40 % of survival, only three patients received an Impella ® in addition to ECMO, and none had premorbid aortic regurgitation [3]. In our opinion, refractory cardiogenic shock associated with severe aortic regurgitation should require immediate aortic valve surgery.We concur with Dr. Staudacher and colleagues that ECMO might be a salvage therapy in case of septic cardiomyopathy with left or right refractory heart failure. Our purpose was to highlight the gap in the results observed for peripheral VA-ECMO therapy during refractory septic shock depending on the hemodynamic profile of the patient. Indeed, in case of septic shock associated-refractory vasoplegia with preserved cardiac output, ECMO support seems to be of little value. Alternatively, acceptable survival rates and preserved long-term quality of life were reported when VA-ECMO was initiated in septic shock patients with severely impaired cardiac function [4].ECMO-treated severe acute respiratory distress syndrome (ARDS) in the context of allogeneic stem cell transplantation (ASCT) has been consistently associated with poor outcome in small pediatric and adult case series. However, we concede that studies focused on its use in this specific adult population are warranted before denying ECMO to any ASCT patient.Lastly, we agree that a multifaceted pre-ECMO evaluation, rather than using age as a unique factor, might be more suitable to estimate long-term prognosis after ECMO. However, Karagiannidis et al. recently highlighted that mortality steadily increased with increasing age, with in-hospital mortality almost reaching 80 % in patients over 80 years old [5] compared to less than 40 % in younger patients. Beyond patient's age, associated comorbidities should also be taken into account. Compliance with ethical standards Conflicts of interestPr Combes is the primary investigator of the EOLIA trial, NCT01470703, a randomized trial of VV-ECMO supported in part by Maquet. Pr Combes has received honoraria for lectures from Maquet.

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confidence: 74%

Four situations in which ECMO might have a chance: response to Staudacher et al.

Schmidt

Bréchot

2016

Intensive Care Med

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“…The first possibility is the application at the moment of triage of different scores validated for MCS implantation for cardiogenic shock, but burdened by a low proportion of ECPR in the derivation or validation cohort (16)(17)(18). We strongly believe that the application of scores outside the original setting is not the right choice to decide the fate of a cardiac arrest patient.…”

Section: Federico Pappalardo 1 Andrea Montiscimentioning

confidence: 99%

What is extracorporeal cardiopulmonary resuscitation?

Pappalardo¹,

Montisci²

2017

J. Thorac. Dis.

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“…The comparison of the discriminatory power of the ENCOURAGE score with the SAVE score showed a significantly better performance of the former, as well as towards other scoring systems for mortality prediction in AMI patients (7).…”

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Is there light at the end of the tunnel?—new perspectives in ECMO survival

Pappalardo¹,

Montisci

2016

J. Thorac. Dis.

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Cardiogenic shock (CS) is a state of systemic hypoperfusion, secondary to a deficit in cardiac contractile activity. Acute myocardial infarction (AMI) accounts for the majority of cases of CS, with a high mortality rate, despite the great improvements in revascularisation therapy. Nowadays, mechanical circulatory support (MCS) in CS often represents the only therapeutic approach able to restore systemic perfusion, determining a survival benefit. Recently, many efforts have been made to identify factors associated with mortality in patients receiving MCS devices. New insights into the pathophysiology of CS prompted the concept that the use of MCS should be considered early in the course of the disease, before the progression to multiorgan dysfunction. However, many questions remain unsolved and randomised trials in this field are hard to perform. Looking at the future, the timely implantation of temporary MCS, the correct selection of patient, the concomitant use of different temporary devices, the improvement in weaning strategies and the increasing use of durable devices as a destination or bridge therapy appear to be the most promising areas of development.

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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: 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.

Cited by 375 publications

References 47 publications

Four situations in which ECMO might have a chance: response to Staudacher et al.

Four situations in which ECMO might have a chance: response to Staudacher et al.

What is extracorporeal cardiopulmonary resuscitation?

Is there light at the end of the tunnel?—new perspectives in ECMO survival

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