Intensive Care Medicine

, Volume 42, Issue 3, pp 370–378 | Cite as

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 CombesEmail author



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.


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.


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.


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.


Extracorporeal membrane oxygenation Acute myocardial infarction Cardiogenic shock Outcome assessment Long-term quality of life 


Compliance with ethical standards

Conflicts of interest

Dr. Combes is the primary investigator of the EOLIA trial, NCT01470703, a randomized trial of VV-ECMO supported in part by MAQUET. Dr. Combes has received honoraria for lectures from MAQUET.

Supplementary material

134_2016_4223_MOESM1_ESM.docx (585 kb)
Supplementary material 1 (DOCX 585 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Grégoire Muller
    • 1
  • Erwan Flecher
    • 3
  • Guillaume Lebreton
    • 2
  • Charles-Edouard Luyt
    • 1
  • Jean-Louis Trouillet
    • 1
  • Nicolas Bréchot
    • 1
  • Matthieu Schmidt
    • 1
  • Ciro Mastroianni
    • 2
  • Jean Chastre
    • 1
  • Pascal Leprince
    • 2
  • Amedeo Anselmi
    • 3
  • Alain Combes
    • 1
    Email author
  1. 1.Medical-Surgical Intensive Care Unit, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisUniversité Pierre et Marie CurieParis Cedex 13France
  2. 2.Cardiac Surgery Department, INSERM, UMRS-1166, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisUniversité Pierre et Marie CurieParis Cedex 13France
  3. 3.Thoracic and Cardio-Vascular Surgery DepartmentCentre Cardio-Pneumologique, Hôpital Universitaire PontchaillouRennes CedexFrance

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