Which Is Better

The purpose of this study is to compare outcomes associated with the use of Impella and TandemHeart short-term support devices with venoarterial extracorporeal membrane oxygenation (ECMO) therapy for postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Between January 2006 and September 2011, 79 patients were supported with either an Impella axial flow pump (n = 7) or a TandemHeart centrifugal pump (n = 11), or with ECMO (n = 61) therapy for cardiogenic shock in a single institution. Pertinent variables and postprocedural events were analyzed in this cohort of patients using a prospectively maintained clinical database. The in-hospital mortality, successful weaning from mechanical circulatory support, bridge to long-term destination support device and heart transplantation, and limb complications did not differ between the 2 groups based on intention-to-treat analysis. Age was the only independent predictor for in-hospital survival. In this cohort of patients, short-term support devices and ECMO achieved comparable results. In the modern era of medical cost restraints, ECMO may be more cost effective for patients with postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Larger randomized trials may be necessary to further elucidate this topic.