Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach

Giovanni Chiarini*, Sung-Min Cho, Glenn Whitman, Frank Rasulo, Roberto Lorusso

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries. These complications have been reported in 7 to 15% of adults and 20% of neonates, and are associated with poor survival. Thromboembolic events, loss of cerebral autoregulation, alteration of the blood-brain barrier, and hemorrhage related to anticoagulation represent the main causes of severe brain injury during ECMO. The most frequent forms of acute neurological injuries in ECMO patients are intracranial hemorrhage (2-21%), ischemic stroke (2-10%), seizures (2-6%), and hypoxic-ischemic brain injury; brain death may also occur in this population. Other frequent complications are infarction (1-8%) and cerebral edema (2-10%), as well as neuropsychological and psychiatric sequelae, including posttraumatic stress disorder.

Original languageEnglish
Pages (from-to)422-436
Number of pages15
JournalSeminars in Neurology
Issue number04
Early online date13 Apr 2021
Publication statusPublished - Aug 2021


  • brain damage
  • neurologic prognostication
  • ECMO
  • extracorporeal life support
  • neuromonitoring

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