Letters to the Editor
In Reply
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Several mechanical circulatory support (MCS) systems have been developed for hemodynamic support and unloading of the left ventricle with the aim of achieving safe and successful coronary revascularization with a more favorable outcome. ECMELLA, which combines extracorporeal life support with the Impella pump and thus offers both left ventricular unloading and cardiac support with high flow velocity, has been advocated as an effective therapy for severe cardiogenic shock (CS); however, there are no randomized trials. Unfortunately, our registry includes no data on the use of ECMELLA. The study by Hlinomaz et al. (1) reports the use of MCS in the Czech Republic. Data on the prognostic impact of MCS are controversial across the studies. The ECMO-CS study (2) showed no improvement in 30-day clinical outcomes after immediate implementation of VA-ECMO in patients with severe CS. In the ECLS-SHOCK trial (3), 30-day mortality in patients with CS who received ECMO was not lower than in those who received medical treatment alone. The DanGer study (4) reported that routine implantation of Impella in addition to standard care is superior to standard care alone, despite of the complications. The results of the large-scale randomized trials will be of interest to define the prognostic role of MCS in CS patients.
DOI: 10.3238/arztebl.m2024.0057
On behalf of the authors
Tamilla Muzafarova, Zuzana Motovska
Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Vinohrady, Prague, Czech Republic;
zuzana.motovska@lf3.cuni.cz
Conflict of interest statement
The authors declare that no conflict of interest exists.
| 1. | Hlinomaz O, Motovska Z, Kala P, et al.: Outcomes of patients with myocardial infarction and cardiogenic shock treated with culprit vessel-only versus multivessel primary PCI. Hellenic J Cardiol 2024; 76: 1–10 CrossRef MEDLINE |
| 2. | Ostadal P, Rokyta R, Karasek J, et al.: Extracorporeal membrane oxygenation in the therapy of cardiogenic shock: results of the ECMO-CS randomized clinical trial. Circulation 2023; 147: 454–64 CrossRef MEDLINE |
| 3. | Thiele H, Zeymer U, Akin I, et al.: Extracorporeal life support in infarct-related cardiogenic shock. N Engl J Med 2023; 389: 1286–97 CrossRef MEDLINE |
| 4. | Muzafarova T, Motovska Z, Hlinomaz O, et al.: The prognosis of cardiogenic shock following acute myocardial infarction—an analysis of 2693 cases from a prospective multicenter registry. Dtsch Arztebl Int 2023; 120: 538–9 VOLLTEXT |
