A systematic review and meta-analysis including 29 studies with 62,656 patients examined risk factors for neurological complications in adult patients on ECMO.[1] Research has identified female gender, pre-ECMO cardiac arrest, renal replacement therapy, and heart failure as factors increasing the risk of complex neurologic complications.[1] Female gender and longer duration of ECMO have been shown to be risk factors for stroke.[1] Intracranial hemorrhage was associated with female gender, increased pre-ECMO lactate, lower pH, lower platelet count, prolonged APTT, and use of vasoactive medications.[1] The research revealed significant publication bias for composite neurological complications, while no such bias was found for stroke and intracranial hemorrhage.[1] The authors recommend protocolized neurologic monitoring and immediate intervention for detected abnormalities given the various causes of neurologic impairment in ECMO patients.[1]