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 (neurologicalmonitoring 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 expertisein ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi processwith 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 earlyphysiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurologicalprognostication, and (5) neurological follow‑up and outcomes. The consensus produced 30 statements and recom‑mendations 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 detec‑tion and timely intervention are crucial for improving outcomes. These consensus recommendations and scientificstatements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO‑associated ABI.