We would like to thank Dr Ferreira for important comments emphasizing the importance of interpreting ECMO-CS (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) trial results within the context of cardiogenic shock pathophysiology. We fully agree with Dr.
Ferreira that too-late initiation of ECMO in patients with severe or rapidly deteriorating cardiogenic shock (Society for Cardiovascular Angiography & Interventions stage D and E) might not reverse systemic processes with microcirculatory failure and that this could partially explain the neutral ECMO-CS trial results.