Which of the following is a major neurological complication reported with ECMO?

• A. Seizures
• B. Stroke
• C. Intracranial bleeding
• D. Encephalopathy

Answer: (C)

The key idea is that ECMO requires systemic anticoagulation to keep the circuit from clotting, which creates a bleeding risk throughout the body, including inside the skull. In the brain, this combination of anticoagulation, platelet dysfunction, and potential coagulopathy can lead to intracranial hemorrhage, a serious and high-mortality complication. While seizures, stroke (ischemic or hemorrhagic), and encephalopathy can occur during ECMO, intracranial bleeding is the most consistently reported major neurologic event because it directly results from the bleeding tendency created by the necessary anticoagulation and the fragile balance of coagulation during support. Clinicians monitor coagulation status, platelet counts, and fibrinogen, adjust anticoagulant dosing carefully, and remain vigilant for neurologic changes that would prompt imaging and treatment adjustments.