Monitoring brain integrity and neurocognitive function is a new and important target for the management of a patient treated with extracorporeal membrane oxygenation (ECMO), in particular because of the increasing awareness of cerebral abnormalities that may potentially occur in this setting. Continuous regular monitoring, as well as repeated assessment for cerebral complications has become an essential element of the ECMO patient management. Besides well-known complications, like bleeding, ischemic stroke, seizures, and brain hypoperfusion, other less defined yet relevant injury and clinical manifestations are increasingly reported and impacting on ECMO patient prognosis at short term. Furthermore, it is becoming more evident that neurologic complication may not occur only in the early phase. Indeed, other potential adverse events related to the long-term neurocognitive function have been also recently documented either in children or adult ECMO patients. Despite increasing awareness of these aspects, generally accepted protocols and clinical management strategies in this respect are still lacking. Current means to monitor brain perfusion or detecting ongoing cerebral tissue injury are rather limited, and most techniques provide indirect or post-insult recognition of irreversible tissue injury. Continuous monitoring of brain perfusion, serial assessment of brain-derived serum biomarkers, timely neuro-imaging, and post-discharge counselling for neurocognitive dysfunction, particularly in pediatric patients, are novel pathways focusing on neurologic assessment with important implications in daily practice to assess brain function and integrity not only during the ECMO-related hospitalization, but also at long-term to re-evaluate the neuropsychological integrity, although well designed studies will be necessary to elucidate the cost-effectiveness of these management strategies.

2nd Department of Medicine Cardiovascular Medicine General Teaching Hospital Charles University Prague Czech Republic

2nd Intensive Care Unit S C Anestesia e Rianimazione Foundation IRCCS S Matteo Pavia Italy

Cardiac Anesthesia and Intensive Care Unit Sant'Andrea Hospital Rome Italy

Cardiac Intensive Care and ECMO Institute of Child Health Great Ormond Street Hospital London UK

Department of Anesthesia and Intensive Care Intraoperative Neurophysiology Treviso Regional Hospital Treviso Italy

Department of Cardio Thoracic Surgery Heart and Vascular Center Maastricht University Medical Center Maastricht The Netherlands

Department of Cardiology and Department of Intensive Care Unit Maastricht University Medical Center Maastricht The Netherlands

Department of Intensive Care Erasmus Medical Center University Medical Center Rotterdam The Netherlands

Department of Intensive Care Kassel Germany

Department of Intensive Care Medicine Université Libre de Bruxelles Hopital Erasme Bruxelles Belgium

Department of Intensive Care Medicine University Hospitals Leuven Belgium

Department of Intensive Care Medicine University Medical Center Utrecht Utrecht The Netherlands

Department of Internal Medicine University Hospital of Regensburg Germany

Intensive Care Unit Royal Hospital for Sick Children Glasgow Scotland

Neonatal Unit Princess Royal Maternity Glasgow Scotland

Pediatric Intensive Care Unit Children's Hospital Bambino Gesù IRCCS Rome Italy

Pediatric Intensive Care Unit Glenfield Hospital Leicester UK

Pediatric Surgery and Intensive Care Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

Surgery Unit Royal Hospital for Sick Children Glasgow Scotland

References provided by Crossref.org

Neurological Monitoring and Management for Adult Extracorporeal Membrane Oxygenation Patients: Extracorporeal Life Support Organization Consensus Guidelines

Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines