BACKGROUND: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support. METHODS: These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened an international multidisciplinary consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels. RESULTS: We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts. CONCLUSIONS: The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.

2nd Department of Medicine Cardiology and Angiologiy General University Hospital and 1st School of Medicine Charles University Prague Czech Republic

Alfaisal University College of Medicine Riyadh Saudi Arabia

Bufalini Hospital AUSL della Romagna Cesena Italy

Cardiorespiratory and Critical Care Division Great Ormond Street Hospital for Children National Health Service Foundation Trust London UK

Cardiothoracic Intensive Care Unit Department of Cardiac Thoracic and Vascular Surgery National University Health System Singapore Singapore

Cardiothoracic Surgery Department Heart and Vascular Centre Maastricht University Medical Centre Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Congenital Heart Center Departments of Surgery and Pediatrics University of Florida Gainesville FL USA

Critical Care Research Group Adult Intensive Care Services The Prince Charles Hospital and University of Queensland Rode Rd Chermside QLD 4032 Australia

Department of Anaesthesiology Intensive Care Emergency and Pain Medicine University Hospital Würzburg Würzburg Germany

Department of Anesthesiology Division of Critical Care University of Virginia Charlottesville VA USA

Department of Critical Care Medicine Guy's and St Thomas' National Health Service Foundation Trust London UK

Department of Intensive Care Erasmus University Medical Center Rotterdam The Netherlands

Department of Intensive Care Hôpital Universitaire de Bruxelles Brussels Belgium

Department of Pediatrics Section Critical Care Medicine Children's Medical Center at Dallas The University of Texas Southwestern Medical Center at Dallas Dallas TX USA

Department of Thoracic and Cardiovascular Surgery Korea University Medicine Seoul Republic of Korea

Departments of Surgery and Pediatrics Creighton University Omaha NE USA

Division of Anaesthesiology Intensive Care and Emergency Medicine Spedali Civili University Affiliated Hospital of Brescia Brescia Italy

Division of Cardiac Surgery Department of Surgery The Johns Hopkins University School of Medicine Baltimore MD USA

Division of Pulmonary and Critical Care Medicine Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD USA

Divisions of Neuroscience Critical Care and Cardiac Surgery Departments of Neurology Neurosurgery and Anaesthesiology and Critical Care Medicine The Johns Hopkins University School of Medicine 600 N Wolfe Street Phipps 455 Baltimore MD 21287 USA

ECMO Department Fundacion Cardiovascular de Colombia Floridablanca Santander Colombia

Medical Critical Care Service Department of Medicine Inova Fairfax Medical Campus Falls Church VA USA

Medical Critical Pharmacy Division King Faisal Specialist Hospital and Research Center 11564 Al Mathar Ash Shamali Riyadh Saudi Arabia

Pediatric Intensive Care Unit Department of Woman Child and Adolescent Medicine Geneva University Hospital Geneva Switzerland

Programa de Oxigenación Por Membrana Extracorpórea Hospital San Juan de Dios Santiago Santiago Chile

Zobrazit více v PubMed

Cho SM, Farrokh S, Whitman G, Bleck TP, Geocadin RG. Neurocritical care for extracorporeal membrane oxygenation patients. Crit Care Med. 2019;47(12):1773–81. 10.1097/CCM.0000000000004060 PubMed DOI

Lorusso R, Gelsomino S, Parise O, Di Mauro M, Barili F, Geskes G, Vizzardi E, Rycus PT, Muellenbach R, Mueller T, et al. Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure: findings from the extracorporeal life support organization database. Crit Care Med. 2017;45(8):1389–97. 10.1097/CCM.0000000000002502 PubMed DOI

Ubben JFH, Heuts S, Delnoij TSR, Suverein MM, van de Koolwijk AF, van der Horst ICC, Maessen JG, Bartos J, Kavalkova P, Rob D, et al. Extracorporeal cardiopulmonary resuscitation for refractory OHCA: lessons from three randomized controlled trials-the trialists’ view. Eur Heart J Acute Cardiovasc Care. 2023;12(8):540–7. 10.1093/ehjacc/zuad071 PubMed DOI PMC

Shou BL, Ong CS, Premraj L, Brown P, Tonna JE, Dalton HJ, Kim BS, Keller SP, Whitman GJR, Cho SM. Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: analysis of the extracorporeal life support organization registry. J Heart Lung Transplant. 2023;42(4):503–11. 10.1016/j.healun.2022.10.019 PubMed DOI PMC

Ong CS, Etchill E, Dong J, Shou BL, Shelley L, Giuliano K, Al-Kawaz M, Ritzl EK, Geocadin RG, Kim BS, et al. Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg. 2023;165(6):2104–10. 10.1016/j.jtcvs.2021.09.063 PubMed DOI

Shoskes A, Migdady I, Rice C, et al. Brain injury is more common in venoarterial extracorporeal membrane oxygenation than venovenous extracorporeal membrane oxygenation: a systematic review and meta-analysis. Crit Care Med. 2020;48(12):1799–808. 10.1097/CCM.0000000000004618. 10.1097/CCM.0000000000004618 PubMed DOI

Cho SM, Ziai W, Mayasi Y, Gusdon AM, Creed J, Sharrock M, Stephens RS, Choi CW, Ritzl EK, Suarez J, et al. Noninvasive neurological monitoring in extracorporeal membrane oxygenation. ASAIO J. 2020;66(4):388–93. 10.1097/MAT.0000000000001013 PubMed DOI

Debaty G, Lamhaut L, Aubert R, Nicol M, Sanchez C, Chavanon O, Bouzat P, Durand M, Vanzetto G, Hutin A, et al. Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest. Resuscitation. 2021;162:163–70. 10.1016/j.resuscitation.2021.02.022 PubMed DOI

Desai M, Wang J, Zakaria A, Dinescu D, Bogar L, Singh R, Dalton H, Osborn E. Fixed and dilated pupils, not a contraindication for extracorporeal support: a case series. Perfusion. 2020;35(8):814–8. 10.1177/0267659120915386 PubMed DOI

Le Guennec L, Shor N, Levy B, Lebreton G, Leprince P, Combes A, Dormont D, Luyt CE. Spinal cord infarction during venoarterial-extracorporeal membrane oxygenation support. J Artif Organs. 2020;23(4):388–93. 10.1007/s10047-020-01179-8 PubMed DOI PMC

Crow J, Lindsley J, Cho SM, Wang J, Lantry JH 3rd, Kim BS, Tahsili-Fahadan P. Analgosedation in critically Ill adults receiving extracorporeal membrane oxygenation support. ASAIO J. 2022;68(12):1419–27. 10.1097/MAT.0000000000001758 PubMed DOI PMC

Cho SM, Ziai W, Geocadin R, Choi CW, Whitman G. Arterial-sided oxygenator clot and TCD emboli in VA-ECMO. Ann Thorac Surg. 2018;107(1):326–7. 10.1016/j.athoracsur.2018.06.082 PubMed DOI

Cho S-M, Geocadin RG, Caturegli G, Chan V, White B, Dodd-o J, Kim BS, Sussman M, Choi CW, Whitman G, et al. Understanding characteristics of acute brain injury in adult ECMO: an autopsy study. Crit Care Med. 2020;94:1650. PubMed

Mateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EF. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol. 2011;68(12):1543–9. 10.1001/archneurol.2011.209 PubMed DOI PMC

Zhao D, Shou BL, Caturegli G, et al. Trends on near-infrared spectroscopy associated with acute brain injury in venoarterial extracorporeal membrane oxygenation. ASAIO J. 2023;69(12):1083–9. 10.1097/MAT.0000000000002032. 10.1097/MAT.0000000000002032 PubMed DOI PMC

Pozzebon S, Blandino Ortiz A, Franchi F, et al. Cerebral near-infrared spectroscopy in adult patients undergoing veno-arterial extracorporeal membrane oxygenation. Neurocrit Care. 2018;29(1):94–104. 10.1007/s12028-018-0512-1. 10.1007/s12028-018-0512-1 PubMed DOI

Bertini P, Marabotti A, Paternoster G, et al. Regional cerebral oxygen saturation to predict favorable outcome in extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2023;37(7):1265–72. 10.1053/j.jvca.2023.01.007. 10.1053/j.jvca.2023.01.007 PubMed DOI

Joram N, Beqiri E, Pezzato S, et al. Continuous monitoring of cerebral autoregulation in children supported by extracorporeal membrane oxygenation: a pilot study. Neurocrit Care. 2021;34(3):935–45. 10.1007/s12028-020-01111-1. 10.1007/s12028-020-01111-1 PubMed DOI

Tian F, Farhat A, Morriss MC, et al. Cerebral hemodynamic profile in ischemic and hemorrhagic brain injury acquired during pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2020;21(10):879–85. 10.1097/PCC.0000000000002438. 10.1097/PCC.0000000000002438 PubMed DOI

Caturegli G, Zhang LQ, Mayasi Y, et al. Characterization of cerebral hemodynamics with TCD in patients undergoing VA-ECMO and VV-ECMO: a prospective observational study. Neurocrit Care. 2023;38(2):407–13. 10.1007/s12028-022-01653-6. 10.1007/s12028-022-01653-6 PubMed DOI PMC

Kavi T, Esch M, Rinsky B, Rosengart A, Lahiri S, Lyden PD. Transcranial doppler changes in patients treated with extracorporeal membrane oxygenation. J Stroke Cerebrovasc Dis. 2016;25(12):2882–5. 10.1016/j.jstrokecerebrovasdis.2016.07.050. 10.1016/j.jstrokecerebrovasdis.2016.07.050 PubMed DOI

Caturegli G, Kapoor S, Ponomarev V, et al. Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: a prospective observational study. JTCVS Tech. 2022;15:111–22. 10.1016/j.xjtc.2022.07.026. 10.1016/j.xjtc.2022.07.026 PubMed DOI PMC

Oddo M, Taccone FS, Petrosino M, et al. The Neurological Pupil index for outcome prognostication in people with acute brain injury (ORANGE): a prospective, observational, multicentre cohort study. Lancet Neurol. 2023;22(10):925–33. 10.1016/S1474-4422(23)00271-5. 10.1016/S1474-4422(23)00271-5 PubMed DOI

Miroz JP, Ben-Hamouda N, Bernini A, et al. Neurological pupil index for early prognostication after venoarterial extracorporeal membrane oxygenation. Chest. 2020;157(5):1167–74. 10.1016/j.chest.2019.11.037. 10.1016/j.chest.2019.11.037 PubMed DOI

Magalhaes E, Reuter J, Wanono R, et al. Early EEG for prognostication under venoarterial extracorporeal membrane oxygenation. Neurocrit Care. 2020;33(3):688–94. 10.1007/s12028-020-01066-3. 10.1007/s12028-020-01066-3 PubMed DOI

Amorim E, Firme MS, Zheng WL, et al. High incidence of epileptiform activity in adults undergoing extracorporeal membrane oxygenation. Clin Neurophysiol. 2022;140:4–11. 10.1016/j.clinph.2022.04.018. 10.1016/j.clinph.2022.04.018 PubMed DOI PMC

Sinnah F, Dalloz MA, Magalhaes E, et al. Early electroencephalography findings in cardiogenic shock patients treated by venoarterial extracorporeal membrane oxygenation. Crit Care Med. 2018;46(5):e389–94. 10.1097/CCM.0000000000003010. 10.1097/CCM.0000000000003010 PubMed DOI

Peluso L, Rechichi S, Franchi F, et al. Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation. Crit Care. 2020;24(1):629. 10.1186/s13054-020-03353-z. 10.1186/s13054-020-03353-z PubMed DOI PMC

Cho SM, Choi CW, Whitman G, et al. Neurophysiological findings and brain injury pattern in patients on ECMO. Clin EEG Neurosci. 2021;52(6):462–9. 10.1177/1550059419892757. 10.1177/1550059419892757 PubMed DOI

Ben-Hamouda N, Ltaief Z, Kirsch M, et al. Neuroprognostication under ecmo after cardiac arrest: Are classical tools still performant? Neurocrit Care. 2022;37(1):293–301. 10.1007/s12028-022-01516-0. 10.1007/s12028-022-01516-0 PubMed DOI

Kim YO, Ko RE, Chung CR, et al. Prognostic value of early intermittent electroencephalography in patients after extracorporeal cardiopulmonary resuscitation. J Clin Med. 2020;9(6):1745. 10.3390/jcm9061745. 10.3390/jcm9061745 PubMed DOI PMC

Lidegran MK, Mosskin M, Ringertz HG, Frenckner BP, Linden VB. Cranial CT for diagnosis of intracranial complications in adult and pediatric patients during ECMO: clinical benefits in diagnosis and treatment. Acad Radiol. 2007;14(1):62–71. 10.1016/j.acra.2006.10.004. 10.1016/j.acra.2006.10.004 PubMed DOI

Cvetkovic M, Chiarini G, Belliato M, et al. International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe. Perfusion. 2023;38(2):245–60. 10.1177/02676591211042563. 10.1177/02676591211042563 PubMed DOI

Malfertheiner MV, Koch A, Fisser C, et al. Incidence of early intra-cranial bleeding and ischaemia in adult veno-arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation patients: a retrospective analysis of risk factors. Perfusion. 2020;35:8–17. 10.1177/0267659120907438. 10.1177/0267659120907438 PubMed DOI

Lockie CJA, Gillon SA, Barrett NA, et al. Severe respiratory failure, extracorporeal membrane oxygenation, and intracranial hemorrhage. Crit Care Med. 2017;45(10):1642–9. 10.1097/CCM.0000000000002579. 10.1097/CCM.0000000000002579 PubMed DOI

Zotzmann V, Rilinger J, Lang CN, et al. Early full-body computed tomography in patients after extracorporeal cardiopulmonary resuscitation (eCPR). Resuscitation. 2020;146:149–54. 10.1016/j.resuscitation.2019.11.024. 10.1016/j.resuscitation.2019.11.024 PubMed DOI

Prokupets R, Kannapadi N, Chang H, et al. Management of anticoagulation therapy in ECMO-associated ischemic stroke and intracranial hemorrhage. Innovations (Phila). 2023;18(1):49–57. 10.1177/15569845221141702. 10.1177/15569845221141702 PubMed DOI PMC

Cho SM, Wilcox C, Keller S, et al. Assessing the SAfety and FEasibility of bedside portable low-field brain Magnetic Resonance Imaging in patients on ECMO (SAFE-MRI ECMO study): study protocol and first case series experience. Crit Care. 2022;26(1):119. 10.1186/s13054-022-03990-6. 10.1186/s13054-022-03990-6 PubMed DOI PMC

Lorusso R, Taccone FS, Belliato M, et al. Brain monitoring in adult and pediatric ECMO patients: the importance of early and late assessments. Minerva Anestesiol. 2017;83(10):1061–74. 10.23736/S0375-9393.17.11911-5. 10.23736/S0375-9393.17.11911-5 PubMed DOI

Khanduja S, Kim J, Kang JK, et al. Hypoxic-ischemic brain injury in ecmo: pathophysiology, neuromonitoring, and therapeutic opportunities. Cells. 2023;12(11):1546. 10.3390/cells12111546. 10.3390/cells12111546 PubMed DOI PMC

de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, Bosman RJ, de Waal RA, Wesselink R, de Keizer NF. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care. 2008;12(6):R156. 10.1186/cc7150 PubMed DOI PMC

Al-Kawaz MN, Canner J, Caturegli G, Kannapadi N, Balucani C, Shelley L, Kim BS, Choi CW, Geocadin RG, Whitman G, et al. Duration of hyperoxia and neurologic outcomes in patients undergoing extracorporeal membrane oxygenation. Crit Care Med. 2021;49(10):e968–77. 10.1097/CCM.0000000000005069 PubMed DOI

Akbar AF, Shou BL, Feng CY, Zhao DX, Kim BS, Whitman G, Bush EL, Cho SM, Investigators H. Lower oxygen tension and intracranial hemorrhage in veno-venous extracorporeal membrane oxygenation. Lung. 2023;201(3):315–20. 10.1007/s00408-023-00618-6 PubMed DOI PMC

Cho SM, Canner J, Chiarini G, Calligy K, Caturegli G, Rycus P, Barbaro RP, Tonna J, Lorusso R, Kilic A, et al. Modifiable risk factors and mortality from ischemic and hemorrhagic strokes in patients receiving venoarterial extracorporeal membrane oxygenation: results from the extracorporeal life support organization registry. Crit Care Med. 2020;48(10):e897–905. 10.1097/CCM.0000000000004498 PubMed DOI PMC

Harper AM, Bell RA. The effect of metabolic acidosis and alkalosis on the blood flow through the cerebral cortex. J Neurol Neurosurg Psychiatry. 1963;26(4):341–4. 10.1136/jnnp.26.4.341 PubMed DOI PMC

Dulla CG, Dobelis P, Pearson T, Frenguelli BG, Staley KJ, Masino SA. Adenosine and ATP link PCO2 to cortical excitability via pH. Neuron. 2005;48(6):1011–23. 10.1016/j.neuron.2005.11.009 PubMed DOI PMC

Meng L, Gelb AW. Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology. 2015;122(1):196–205. 10.1097/ALN.0000000000000506 PubMed DOI

Deng B, Ying J, Mu D. Subtypes and mechanistic advances of extracorporeal membrane oxygenation-related acute brain injury. Brain Sci. 2023;13(8):1165. 10.3390/brainsci13081165 PubMed DOI PMC

Cavayas YA, Munshi L, Del Sorbo L, Fan E. The early change in Pa. Am J Respir Crit Care Med. 2020;201(12):1525–35. 10.1164/rccm.202001-0023OC PubMed DOI

Shou BL, Ong CS, Zhou AL, Al-Kawaz MN, Etchill E, Giuliano K, Dong J, Bush E, Kim BS, Choi CW, et al. Arterial carbon dioxide and acute brain injury in venoarterial extracorporeal membrane oxygenation. ASAIO J. 2022;42(4):503–11. PubMed PMC

van der Worp HB, Sena ES, Donnan GA, Howells DW, Macleod MR. Hypothermia in animal models of acute ischaemic stroke: a systematic review and meta-analysis. Brain. 2007;130(Pt 12):3063–74. 10.1093/brain/awm083 PubMed DOI

Huang M, Shoskes A, Migdady I, Amin M, Hasan L, Price C, Uchino K, Choi CW, Hernandez AV, Cho SM. Does targeted temperature management improve neurological outcome in extracorporeal cardiopulmonary resuscitation (ECPR)? J Intensive Care Med. 2022;37(2):157–67. 10.1177/08850666211018982 PubMed DOI

Levy B, Girerd N, Amour J, Besnier E, Nesseler N, Helms J, Delmas C, Sonneville R, Guidon C, Rozec B, et al. Effect of moderate hypothermia vs normothermia on 30-day mortality in patients with cardiogenic shock receiving venoarterial extracorporeal membrane oxygenation: a randomized clinical trial. JAMA. 2022;327(5):442–53. 10.1001/jama.2021.24776 PubMed DOI PMC

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2018;49(3):e46–110. 10.1161/STR.0000000000000158 PubMed DOI

Minhas JS, Moullaali TJ, Rinkel GJE, Anderson CS. Blood pressure management after intracerebral and subarachnoid hemorrhage: the knowns and known unknowns. Stroke. 2022;53(4):1065–73. 10.1161/STROKEAHA.121.036139 PubMed DOI

Kazmi SO, Sivakumar S, Karakitsos D, Alharthy A, Lazaridis C. Cerebral pathophysiology in extracorporeal membrane oxygenation: pitfalls in daily clinical management. Crit Care Res Pract. 2018;2018:3237810. PubMed PMC

Shou BL, Wilcox C, Florissi I, Kalra A, Caturegli G, Zhang LQ, Bush E, Kim B, Keller SP, Whitman GJR, et al. Early low pulse pressure in VA-ECMO is associated with acute brain injury. Neurocrit Care. 2023;38(3):612–21. 10.1007/s12028-022-01607-y PubMed DOI PMC

Lee SI, Lim YS, Park CH, Choi WS, Choi CH. Importance of pulse pressure after extracorporeal cardiopulmonary resuscitation. J Card Surg. 2021;36(8):2743–50. 10.1111/jocs.15614 PubMed DOI

Risnes I, Wagner K, Nome T, et al. Cerebral outcome in adult patients treated with extracorporeal membrane oxygenation. Ann Thorac Surg. 2006;81(4):1401–6. 10.1016/j.athoracsur.2005.10.008. 10.1016/j.athoracsur.2005.10.008 PubMed DOI

von Bahr V, Kalzen H, Hultman J, et al. Long-term cognitive outcome and brain imaging in adults after extracorporeal membrane oxygenation. Crit Care Med. 2018;46(5):e351–8. 10.1097/CCM.0000000000002992. 10.1097/CCM.0000000000002992 PubMed DOI

Ropper AH, O’Rourke D, Kennedy SK. Head position, intracranial pressure, and compliance. Neurology. 1982;32(11):1288–91. 10.1212/WNL.32.11.1288 PubMed DOI

Blanco P, Abdo-Cuza A. Transcranial Doppler ultrasound in neurocritical care. J Ultrasound. 2018;21(1):1–16. 10.1007/s40477-018-0282-9 PubMed DOI PMC

Miller C, Armonda R. Participants in the International Multi-disciplinary Consensus conference on Multimodality Monitoring of cerebral blood flow and ischemia in the critically ill. Neurocrit Care. 2014;21(2):1–26.

Raha O, Hall C, Malik A, D’Anna L, Lobotesis K, Kwan J, Banerjee S. Advances in mechanical thrombectomy for acute ischaemic stroke. BMJ Med. 2023;2(1): e000407. 10.1136/bmjmed-2022-000407 PubMed DOI PMC

Friesenecker BE, Peer R, Rieder J, Lirk P, Knotzer H, Hasibeder WR, Mayr AJ, Dunser MW. Craniotomy during ECMO in a severely traumatized patient. Acta Neurochir (Wien). 2005;147(9):993–6. 10.1007/s00701-005-0568-5 PubMed DOI

Ryu KM, Chang SW. Heparin-free extracorporeal membrane oxygenation in a patient with severe pulmonary contusions and bronchial disruption. Clin Exp Emerg Med. 2018;5(3):204–7. 10.15441/ceem.17.252 PubMed DOI PMC

Lamarche Y, Chow B, Bedard A, Johal N, Kaan A, Humphries KH, Cheung A. Thromboembolic events in patients on extracorporeal membrane oxygenation without anticoagulation. Innovations (Phila). 2010;5(6):424–9. 10.1177/155698451000500608 PubMed DOI

Fina D, Matteucci M, Jiritano F, Meani P, Lo Coco V, Kowalewski M, Maessen J, Guazzi M, Ballotta A, Ranucci M, Lorusso R. Extracorporeal membrane oxygenation without therapeutic anticoagulation in adults: a systematic review of the current literature. Int J Artif Organs. 2020;43(9):570–8. 10.1177/0391398820904372 PubMed DOI

Fletcher-Sandersjoo A, Thelin EP, Bartek J Jr, Elmi-Terander A, Broman M, Bellander BM. Management of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation (ECMO): an observational cohort study. PLoS ONE. 2017;12(12): e0190365. 10.1371/journal.pone.0190365 PubMed DOI PMC

Mazzeffi M, Kon Z, Menaker J, Johnson DM, Parise O, Gelsomino S, Lorusso R, Herr D. Large dual-lumen extracorporeal membrane oxygenation cannulas are associated with more intracranial hemorrhage. ASAIO J. 2019;65(7):674–7. 10.1097/MAT.0000000000000917 PubMed DOI

Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral venous thrombosis: a comprehensive review. Eur Neurol. 2020;83(4):369–79. 10.1159/000509802 PubMed DOI

Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY, Stroke C, American Heart Association, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158–92. 10.1161/STR.0b013e31820a8364 PubMed DOI

Einhaupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F. European federation of neurological S: EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010;17(10):1229–35. 10.1111/j.1468-1331.2010.03011.x PubMed DOI

Nolan JP, Sandroni C, Bottiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, et al. European resuscitation council and european society of intensive care medicine guidelines 2021: post-resuscitation care. Resuscitation. 2021;161:220–69. 10.1016/j.resuscitation.2021.02.012 PubMed DOI

Nutma S, Ruijter BJ, Beishuizen A, Tromp SC, Scholten E, Horn J, van den Bergh WM, van Kranen-Mastenbroek VH, Thomeer EC, Moudrous W, et al. Myoclonus in comatose patients with electrographic status epilepticus after cardiac arrest: corresponding EEG patterns, effects of treatment and outcomes. Resuscitation. 2023;186: 109745. 10.1016/j.resuscitation.2023.109745 PubMed DOI

Peluso L, Oddo M, Minini A, Citerio G, Horn J, Di Bernardini E, Rundgren M, Cariou A, Payen JF, Storm C, et al. Neurological pupil index and its association with other prognostic tools after cardiac arrest: a post hoc analysis. Resuscitation. 2022;179:259–66. 10.1016/j.resuscitation.2022.07.030 PubMed DOI

Elmer J, Kurz MC, Coppler PJ, Steinberg A, DeMasi S, De-Arteaga M, Simon N, Zadorozhny VI, Flickinger KL, Callaway CW, et al. Time to awakening and self-fulfilling prophecies after cardiac arrest. Crit Care Med. 2023;51(4):503–12. 10.1097/CCM.0000000000005790 PubMed DOI PMC

Cho SM, Khanduja S, Kim J, Kang JK, Briscoe J, Arlinghaus LR, Dinh K, Kim BS, Sair HI, Wandji AN, Moreno E, Torres G, Gavito-Higuera J, Choi HA, Pitts J, Gusdon AM, Whitman GJ. detection of acute brain injury in intensive care unit patients on ECMO support using ultra-low-field portable mri: a retrospective analysis compared to head CT. Diagnostics (Basel). 2024;14(6):606. 10.3390/diagnostics14060606 PubMed DOI PMC

Cho SM, Khanduja S, Wilcox C, Dinh K, Kim J, Kang JK, Chinedozi ID, Darby Z, Acton M, Rando H, Briscoe J, Bush E, Sair HI, Pitts J, Arlinghaus LR, Wandji AN, Moreno E, Torres G, Akkanti B, Gavito-Higuera J, Keller S, Choi HA, Kim BS, Gusdon A, Whitman GJ. Clinical use of bedside portable low-field brain magnetic resonance imaging in patients on ECMO: The results from multicenter SAFE MRI ECMO study. Res Sq [Preprint]. 2024

Rajajee V, Muehlschlegel S, Wartenberg KE, Alexander SA, Busl KM, Chou SHY, Creutzfeldt CJ, Fontaine GV, Fried H, Hocker SE, et al. Guidelines for neuroprognostication in comatose adult survivors of cardiac arrest. Neurocrit Care. 2023;38(3):533–63. 10.1007/s12028-023-01688-3 PubMed DOI PMC

Sandroni C, D’Arrigo S, Cacciola S, et al. Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med. 2022;48(4):389–413. 10.1007/s00134-022-06618-z. 10.1007/s00134-022-06618-z PubMed DOI PMC

Moynihan KM, Dorste A, Siegel BD, Rabinowitz EJ, McReynolds A, October TW. Decision-making, ethics, and end-of-life care in pediatric extracorporeal membrane oxygenation: a comprehensive narrative review. Pediatr Crit Care Med. 2021;22(9):806–12. 10.1097/PCC.0000000000002766. 10.1097/PCC.0000000000002766 PubMed DOI

Onrust M, Lansink-Hartgring AO, van der Meulen I, Luttik ML, de Jong J, Dieperink W. Coping strategies, anxiety and depressive symptoms in family members of patients treated with extracorporeal membrane oxygenation: a prospective cohort study. Heart Lung Mar. 2022;52:146–51. 10.1016/j.hrtlng.2022.01.002.10.1016/j.hrtlng.2022.01.002 PubMed DOI

Wirpsa MJ, Carabini LM, Neely KJ, Kroll C, Wocial LD. Mitigating ethical conflict and moral distress in the care of patients on ECMO: impact of an automatic ethics consultation protocol. J Med Ethics. 2021. 10.1136/medethics-2020-106881. 10.1136/medethics-2020-106881 PubMed DOI

Petermichl W, Philipp A, Hiller KA, Foltan M, Floerchinger B, Graf B, Lunz D. Reliability of prognostic biomarkers after prehospital extracorporeal cardiopulmonary resuscitation with target temperature management. Scand J Trauma Resusc Emerg Med. 2021;29(1):147. 10.1186/s13049-021-00961-8 PubMed DOI PMC

Gregorio T, Pipa S, Cavaleiro P, Atanasio G, Albuquerque I, Castro Chaves P, Azevedo L. Original intracerebral hemorrhage score for the prediction of short-term mortality in cerebral hemorrhage: systematic review and meta-analysis. Crit Care Med. 2019;47(6):857–64. 10.1097/CCM.0000000000003744 PubMed DOI

Cho SM, Canner J, Caturegli G, Choi CW, Etchill E, Giuliano K, Chiarini G, Calligy K, Rycus P, Lorusso R, et al. Risk factors of ischemic and hemorrhagic strokes during venovenous extracorporeal membrane oxygenation: analysis of data from the extracorporeal life support organization registry. Crit Care Med. 2021;49(1):91–101. 10.1097/CCM.0000000000004707 PubMed DOI PMC

Hwang J, Kalra A, Shou BL, Whitman G, Wilcox C, Brodie D, Zaaqoq AM, Lorusso R, Uchino K, Cho SM. Epidemiology of ischemic stroke and hemorrhagic stroke in venoarterial extracorporeal membrane oxygenation. Crit Care. 2023;27(1):433. 10.1186/s13054-023-04707-z PubMed DOI PMC

Lie SA, Hwang NC. Challenges of brain death and apnea testing in adult patients on extracorporeal corporeal membrane oxygenation-a review. J Cardiothorac Vasc Anesth. 2019;33(8):2266–72. 10.1053/j.jvca.2019.01.042 PubMed DOI

Machado DS, Garros D, Montuno L, Avery LK, Kittelson S, Peek G, Moynihan KM. Finishing well: compassionate extracorporeal membrane oxygenation discontinuation. J Pain Symptom Manage. 2022;63(5):e553–62. 10.1016/j.jpainsymman.2021.11.010 PubMed DOI

Kalra A, Kang JK, Khanduja S, Menta AK, Ahmad SA, Liu O, Rodriguez E, Spann M, Hernandez AV, Brodie D, et al. Long-term neuropsychiatric, neurocognitive, and functional outcomes of patients receiving ECMO. Neurology. 2024;102(3): e208081. 10.1212/WNL.0000000000208081 PubMed DOI PMC

Risnes I, Heldal A, Wagner K, et al. Psychiatric outcome after severe cardio-respiratory failure treated with extracorporeal membrane oxygenation: a case-series. Psychosomatics. 2013;54(5):418–27. 10.1016/j.psym.2013.02.008. 10.1016/j.psym.2013.02.008 PubMed DOI

Janssen MF, Bonsel GJ, Luo N. Is EQ-5D-5L better than EQ-5D-3L? A head-to-head comparison of descriptive systems and value sets from seven countries. Pharmacoeconomics. 2018;36(6):675–97. 10.1007/s40273-018-0623-8. 10.1007/s40273-018-0623-8 PubMed DOI PMC