Following PRISMA guidelines, we searched PubMed, Embase, CINHAL, Scopus, Cochrane, Web of Science, and ClinicalTrials.gov for observational and randomized clinical trials reporting neurologic outcomes and survival outcomes of patients receiving VV-ECMO for respiratory failure. In trials including both VA-ECMO and VV-ECMO, only subjects with VV-ECMO were analyzed for outcomes.

A total of 3695 articles were screened resulting in 363 studies assessed for full-text eligibility. Of 81 studies satisfying search criteria for neurologic complications and outcomes after ECMO, 11 retrospective studies included 6352 patients receiving VV-ECMO for primary indication of respiratory failure. Median patient age was 46 (IQR 44-50). Median VV-ECMO support days was 10 (IQR 9-10.5). Ischemic stroke was reported in 123 (2%) patients in 8 studies (total n=5912), intracranial hemorrhage in 282 (4.5%) patients in 10 studies (total n=6318), and subarachnoid hemorrhage in 25 (2.7%) patients in 5 studies (n=933). Seizure was reported in 61 (1.5%) patients within 6 studies (total n=5806). Brain death was only reported in three studies (0.8%, total n=358 patients). Patient mortality directly related to neurologic complications occurred in 358 (6.6%) patients reported over 5 studies (total n=5465).

Neurologic complications are not uncommon in patients receiving VV-ECMO, and can directly account for mortality in a clinically significant group of patients. No controlled trials have evaluated neurologic outcomes with VV-ECMO.