We appreciate the insightful comments of Tanabe et al
. [
1] and the opportunity to further discuss our findings [
2]. Retrospectively identifying and unifying the cause of death in critically ill patients is extremely challenging. Even prospectively, determining a singular cause of mortality in patients with refractory cardiogenic shock is difficult. Multiple organ failure (MOF) is frequently cited as the primary cause of death without identifying its initial trigger. Additionally, a death occurring after extracorporeal membrane oxygenation (ECMO) weaning may still be associated with ECMO-related complications, such as limb ischemia, pulmonary embolism, stroke, or cannula infection. Therefore, distinguishing between ECMO-related and non-ECMO-related causes of death becomes even more complex. …