In Response

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The authors thank Cropsey et al for their letter regarding our article. They make many excellent points that deserve further discussion. To answer the question regarding the cardiac function of our patients, we analyzed the transesophageal echocardiography examinations performed prior to extracorporeal membrane oxygenation insertion on 8 of 17 patients and found all had normal left ventricular function. Only 1 had abnormal right ventricular function, which was mildly decreased systolic function. Due to a snafu in uploading examinations, we have lost the remaining 9 examinations. To help the readers understand the combination of pressors used, the vast majority of the pressor infusions, expressed as norepinephrine equivalents, were combinations of norepinephrine, vasopressin, and phenylephrine. Nine of the patients also had epinephrine, dopamine, or both running at relatively low doses compared to the vasopressors. For all patients, the main reduction in pressor requirement was weaning vasopressors, primarily norepinephrine.
We hope that this information can inform the community of physicians managing patients with severe acute respiratory failure who are candidates for extracorporeal membrane oxygenation.
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