In a recent issue of Intensive Care Medicine, we read with great interest the article by Moyon et al. [1] who retro-spectively studied the outcomes of immunocompromised patients with cardiogenic shock treated with venoarte-rial extracorporeal membrane oxygenation (VA-ECMO). They showed that immunocompromised patients under-going VA-ECMO treatment have a high 90-day mortal-ity rate of 70%, and that an immunocompromised status is independently associated with mortality. Since these are important findings for evaluating appropriate indica-tions for VA-ECMO in immunocompromised patients, we appreciate this research for providing clinically useful information. However, several factors potentially affect-ing their results should be discussed.

First, the causes of death in the immunocompromised patients studied were unclear. The authors showed that the duration of VA-ECMO was approximately 1  week, the duration of stay in the intensive care unit (ICU) was about 2 weeks, and ICU mortality was about 60% in both immunocompromised and non-immunocompromised patient groups, with no significant difference in these variables. These findings might suggest no difference in mortality associated with VA-ECMO management for cardiogenic shock in the two groups.

In general, sepsis is a common cause of death in immunocompromised patients, with mortality rates reported to exceed 50% [2]. Therefore, it is important to evaluate whether or not the cause of death in the studied patients was associated with VA-ECMO.