Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

To the Editor: In the ECLS-SHOCK trial, Thiele et al. (Oct. 5 issue)(1) compared early extracorporeal life support (ECLS) plus usual medical treatment with usual medical treatment alone in patients with infarct-related cardiogenic shock and found no significant between-group difference with respect to death from any cause at 30 days. However, the extremely low incidence of mechanical discharge (5.8%) in the ECLS group may have provided nonoptimal left ventricular unloading and potential cardiopulmonary overload with an associated dismal prognosis.(2) Alternatively, these patients might have been assigned to receive ECLS too early or did not require ECLS at all, as highlighted . . .