https://doi.org/10.1177/0267659120932705 Perfusion 1–10 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0267659120932705 journals.sagepub.com/home/prf Background The last decade has experienced a surge in the use of extracorporeal membrane oxygenation (ECMO) in adults. 1 However, it is an invasive and relatively high- risk intervention. One of the most dreaded complica- tions from ECMO support is intracranial hemorrhage. In a recent analysis of the Extracorporeal Life Support Organization (ELSO) Registry, the incidence of intra- cranial hemorrhage was 1.8% in patients supported with venoarterial (VA) ECMO 2 and 3.6% in venovenous (VV) ECMO. 3 However, an incidence as high as 16.4% has been reported in a cohort that used standardized screening with neuroimaging. 4 Hospital survival ranges from 0% to 68%. 4,5 In a large US registry of hospital admissions, not only did ECMO patients with intracra- nial hemorrhage have a lower survival rate, but they also had a significantly longer mean length of stay and sig- nificantly higher hospitalization costs compared to those who did not have an intracranial hemorrhage. 5 The substantial variation in incidence and prognosis 6 Intracranial hemorrhage on extracorporeal membrane oxygenation: an international survey Yiorgos Alexandros Cavayas, 1,2,3 Lorenzo Del Sorbo, 1 Laveena Munshi, 4 Caroline Sampson 5 and Eddy Fan 1 Abstract Introduction: Intracranial hemorrhage is one of the most dreaded complications associated with extracorporeal membrane oxygenation. However, robust data to guide clinical practice are lacking. We aimed to describe the current perceptions and practices surrounding the risk, prevention, diagnosis, management, and prognosis of intracranial hemorrhage in patients on extracorporeal membrane oxygenation. Methods: We conducted an international, cross-sectional survey of adult extracorporeal membrane oxygenation centers using a self-administered electronic questionnaire sent to medical directors and program coordinators of all 290 adult centers member of the Extracorporeal Life Support Organization. Results: There were 143 respondents (49%). The median proportion of patients having neuroimaging performed was only 1-25% in venovenous-extracorporeal membrane oxygenation patients and 26-50% in venoarterial-extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation. The majority of participants (58%) tolerated a PaO 2 < 60 mm Hg on venovenous-extracorporeal membrane oxygenation. Lower PaO 2 targets were inversely correlated with the reported incidence of intracranial hemorrhage (r =-0.247; p = 0.024). In patients with intracranial hemorrhage, most participants reported stopping anticoagulation, and median targets for blood product administration were 70,000-99,000 platelets/μL, 1.5-1.9 of international normalized ratio, and 1.6-2.0 g/L of fibrinogen. Conclusion: We found significant heterogeneity in the perceptions and practices. This underlines the need for more research to appropriately guide patient management. Importantly, neuroimaging was performed only in a minority of patients. Considering the important management implications reported by most centers when intracranial hemorrhage is diagnosed, perhaps clinicians should consider widening their indications for early neuroimaging. Keywords extracorporeal membrane oxygenation; intracranial hemorrhage; neurological complications 1 Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, Toronto, ON, Canada 2 Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada 3 Montreal Heart Institute, Montreal, QC, Canada 4 Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, ON, Canada 5 University Hospitals of Leicester, Leicester, East Midlands, UK Corresponding author: Eddy Fan, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada. Email: eddy.fan@uhn.ca 932705PRF 0 0 10.1177/0267659120932705PerfusionCavayas et al. research-article 2020 Orignial Paper