I congratulate Giuliani and colleagues for their successful management of a patient with acute anteroseptal ST-elevation myocardial infarction and cardiogenic shock using a combination of Impella CP and veno-arterial extracorporeal membrane oxygenation (ECMO). I completely agree with them to use a combination of Impella and ECMO recently called ECPELLA which accomplishes both systemic circulatory support and left ventricular unloading. However, I have one concern in improving coronary oxygenation.