Neurological Outcomes in Patients Supported by Veno-arterial Extracorporeal Membrane Oxygenation: A Single-center Study from India

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a vital supportive therapy in cases of severe cardiac or cardiopulmonary failure.However, it carries a high risk of neurological complications, which can significantly influence survival and long-term outcomes.This retrospective study analyzed adult patients who underwent VA-ECMO at a tertiary care center in India between August 2022 and March 2025.Among the 18 patients (mean age 50.9 years), the predominant indication for ECMO was acute myocardial infarction (MI) with cardiogenic shock.Neurological complications occurred in 33.3% of patients, including ischemic stroke, intracranial (IC) hemorrhage, hypoxic-ischemic encephalopathy, and brain death.These complications were associated with increased mortality (66.6 vs 50%) and shorter ECMO duration (3.7 vs 4.5 days).Older patients (>60 years) showed a higher risk, while no complications occurred in the 20-40 age-group.The incidence observed was higher than global registry data, possibly due to differences in patient selection, protocols, or monitoring availability.Mechanisms of neurologic injury include embolic events, hypoperfusion, anticoagulation-related bleeding, and rapid shifts in oxygen and carbon dioxide levels.In resource-limited settings, a tiered neurological monitoring approach combining structured clinical exams, selective imaging, and the judicious use of tools like electroencephalography (EEG) is practical and necessary.Emphasis on careful anticoagulation, maintaining cerebral perfusion, and staff training is essential to mitigate risks.This study underscores the critical need for early recognition and the prevention of neurological complications in ECMO patients, especially in developing countries, to improve outcomes and guide resource-appropriate care strategies.