Extracorporeal membrane oxygenation (ECMO) is increasingly used to provide mechanical support in refractory acute respiratory distress syndrome and/ or refractory cardiogenic shock. It is associated with a high prevalence of neurological complications (i.e., brain death, cerebral ischemia, intracranial hemorrhage, and seizures), which are reported in 15% of adults [1]. These neurological complications are associated with brain injury, increased short-term mortality, functional disability, and reduced quality of life in survivors [1, 2]. Early neurological evaluation remains difficult during ECMO support as most patients are comatose and/ or receive sedative infusion in the acute phase. Bedside repeatable neuromonitoring holds promise for early identification of neurological compromise, enabling timely interventions to prevent secondary insults leading to improved neurological outcomes. Neuromonitoring may also aid in prognostication. Its importance is supported by an international survey [3] and statement [4]. However, its role in this group of patients is not yet established and its performance in the early detection of neurological compromise and effect on outcome is not yet clear. Therefore, no specific recommendations are available for clinicians on this topic.