Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for the management of refractory cardiogenic shock. Although VA-ECMO can stabilize hemodynamics and improve systemic flow, morbidity, and mortality on support remain high.¹ Neurologic injuries, including ischemic brain injuries and central nervous system bleeding, are common in patients supported by VA-ECMO and are important contributors to morbidity and mortality.² Previous studies have identified longer duration of support, higher pump flow, hyperoxemia, and other factors as predictors of acute brain injury (ABI) while on VA-ECMO.³ Due to the physiology of continuous flow cerebral perfusion on VA-ECMO, research has also focused on low pulse pressure during support as a potential mechanism for ABI. One small, single-center cohort previously demonstrated that low pulse pressure was associated with ABI.⁴ To further investigate the relationship between pulse pressure and ABI during VA-ECMO support, Kalra et al.⁵ analyzed data from the global Extracorporeal Life Support Organization (ELSO) Registry, with findings published in this issue of the ASAIO Journal.