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Fulminant myocarditis and extracorporeal membrane oxygenation: what we know, what is there still to learn?

article shows a dramatic decrease in mortality in the first year of the report. Although this may represent a statistical outlier, and there are other possible explanations (the distribution of the comorbidity scores as shown in Figure 5 is different, with more patients in both the highest and lowest tertiles, and the use of Swan-Ganz catheters is decreased), it seems possible that this represents an effect of organizational changes within the intensive care units changes that tend to have their most dramatic effect when first implemented. As institutional leaders begin to pay attention to broad organizational issues within intensive care units, improvements in communication and other processes of care can improve both efficiency and outcomes. It is time for another shift in the coronary care unit zeitgeist. As the article by Dr. Katz et al demonstrates, the coronary care unit is becoming more and more similar to other intensive care units. Accordingly, practitioners in these units need to think of themselves as intensivists. This shift in thinking needs to be accompanied by changes in institutional structures and by congruent changes in training programs, especially those in cardiovascular diseases. The high technology methodology of the future is the sort of broadly inclusive multiprofessional and multidisciplinary approach to patient care that comes naturally to the best critical care professionals. Steven M. Hollenberg, MD Sections of Cardiology and Critical Care Medicine Cooper University Hospital Camden, New Jersey