Critical Care Medicine www.ccmjournal.org e1277 especially after suffering an acute shock (4), this may have impacted on the follow-up treatment. Fitting this theory, patients in the delayed group died considerably more often as a consequence of cardiogenic shock, whereas at the same time, Impella support duration and length of ICU stay were considerably shorter. We were not able to find details about the number of patients in each group who were upgraded to venoarterial extracorporeal membrane oxygenation or ultimately received an LVAD or heart transplant.All-in-all, we share the authors' enthusiasm for the current topic. Nevertheless, we believe that the observed survival difference might, at least in part, be explained by methodological limitations, mandating further analyses in this intriguing field.