Improved Survival Through Early Versus Late Impella Support for Myocardial Infarction–Related Shock? Mind Your Step!

Abstract

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.

The authors reply

“…We are most grateful to Meuwese et al (1) for their interest in our study (2) as well as their observations and thoughtful critique. In the following text, we address all remarks made by Meuwese et al (1) point by point.…”

“…The unloading of the left ventricle with an Impella device could also benefit an octogenarian in previously good biological state until resolution of shock or until definite decisions can be made according to clinical situations. Furthermore, Meuwese et al (1) concentrate only on the survival outcomes of the study in their commentary. Very importantly, patients who had Impella support initiated before PCI had also significantly lower lactate levels, significantly lower serum creatinine levels at 72 hours (despite significantly higher volumes of contrast media used), and a significantly faster reduction of inotropic and vasopressor support compared with those who received Impella support after PCI.…”