Best Evidence Summary of Brain Function Monitoring and Management in Patients Receiving Extracorporeal Membrane Oxygenation.

BACKGROUND

Neurological complications are among the most serious adverse events in patients receiving extracorporeal membrane oxygenation (ECMO). Brain injury during ECMO is associated with increased mortality, long-term neurological deficits and impaired quality of life. Current evidence regarding brain function monitoring and management in ECMO patients is scattered, varies in methodological quality and remains controversial in certain areas. Furthermore, standardised recommendations for monitoring and management across different ECMO configurations and patient populations have yet to be established.

AIMS: To retrieve, appraise and synthesise the best available evidence on brain function monitoring and management in adult patients receiving ECMO and to provide evidence-based guidance for clinical nursing practice.

STUDY

DESIGN

An evidence summary was conducted following the 6S evidence pyramid model. Guideline repositories, professional society websites, evidence-based resources and electronic databases were systematically searched from inception to July 2026. Two reviewers independently performed literature screening, quality appraisal, evidence extraction and synthesis.

RESULTS

Twenty-eight articles were included, comprising 4 guidelines, 6 expert consensuses, 5 systematic reviews and 13 original studies. Thirty-four evidence-based recommendations were identified, covering five domains: risk factor assessment, brain function monitoring, brain injury prevention, brain injury treatment and prognosis and continuity of care.

CONCLUSIONS

The synthesised evidence provides an evidence-based framework for brain function monitoring and management in patients receiving ECMO support. These recommendations may assist healthcare professionals in identifying neurological risks, implementing multimodal neuromonitoring strategies, preventing secondary brain injury and improving neurological outcomes.

RELEVANCE TO CLINICAL PRACTICE: This evidence summary provides nurses and critical care teams with practical guidance for the implementation of multimodal neuromonitoring, individualised brain injury prevention and management strategies in ECMO patients.

REVIEW REGISTRATION: PROSPERO CRD420261370955 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=261370955).