BACKGROUND: Adverse neurological events during extracorporeal membrane oxygenation (ECMO) are common and may be associated with devastating consequences. Close monitoring, early identification and prompt intervention can mitigate early and late neurological morbidity. Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important to optimize outcomes in both adults and children. OBJECTIVE: To assess current practice of neuromonitoring during ECMO and neurocognitive/neurodevelopmental follow-up after ECMO across Europe and to inform the development of neuromonitoring and follow-up guidelines. METHODS: The EuroELSO Neurological Monitoring and Outcome Working Group conducted an electronic, web-based, multi-institutional, multinational survey in Europe. RESULTS: Of the 211 European ECMO centres (including non-ELSO centres) identified and approached in 23 countries, 133 (63%) responded. Of these, 43% reported routine neuromonitoring during ECMO for all patients, 35% indicated selective use, and 22% practiced bedside clinical examination alone. The reported neuromonitoring modalities were NIRS (n = 88, 66.2%), electroencephalography (n = 52, 39.1%), transcranial Doppler (n = 38, 28.5%) and brain injury biomarkers (n = 33, 24.8%). Paediatric centres (67%) reported using cranial ultrasound, though the frequency of monitoring varied widely. Before hospital discharge following ECMO, 50 (37.6%) reported routine neurological assessment and 22 (16.5%) routinely performed neuroimaging with more paediatric centres offering neurological assessment (65%) as compared to adult centres (20%). Only 15 (11.2%) had a structured longitudinal follow-up pathway (defined followup at regular intervals), while 99 (74.4%) had no follow-up programme. The majority (n = 96, 72.2%) agreed that there should be a longitudinal structured follow-up for ECMO survivors. CONCLUSIONS: This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.

2nd Anaesthesia and Intensive Care Unit S Matteo Hospital IRCCS Pavia Italy

2nd Department of Internal Medicine Cardiovascular Medicine General Teaching Hospital and 1st Medical School Charles University Prague Praha Czech Republic

2nd Intensive Care Unit Spedali Civili University of Brescia Brescia Italy

Anaesthesia and Multi Speciality Intensive Care Integrated University Hospital of Verona Italy

Cardiac Intensive Care and ECMO Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health London UK

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

Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Department Intensive Care Medicine University Hospital Leuven Leuven Belgium

Department of Anaesthesia and Intensive Care Klinikum Kassel GmbH Kassel Germany

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

Department of Critical Care Guy's and St Thomas' NHS Foundation Trust London UK

Department of Intensive Care Erasmus University Medical Center Rotterdam The Netherlands

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

Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden

ECMO Centre Karolinska Department of Pediatric Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden

ECMO Centre University Hospital Regensburg Germany

Intensive Care Center University Medical Centre Utrecht The Netherlands

Neonatal Unit Princess Royal Maternity Glasgow Scotland

Paediatric Intensive Care Bambino Gesù Children's Hospital Rome Italy

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

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

Royal Hospital for Children Glasgow Scotland

Sorbonne Université INSERM UMRS_1166 iCAN Institute of Cardiometabolism and Nutrition Assistance Publique Hôpitaux de Paris Pitié Salpêtrière Hospital Medical Intensive Care Unit Paris France

Surgery Unit Royal Hospital for Children Glasgow Scotland

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