Background Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, severe respiratory insufficiency, mostly complicated by persistent pulmonary hypertension. However, cerebral damage, intracerebral haemorrhage as well as ischemia belong to the most devastating complications of ECMO.

Objectives Objectives of the presentation are to give insights into what is known from literature concerning cerebral damage related to neonatal ECMO treatment for pulmonary reasons.

Methods A short introduction in ECMO indications and technical aspects of ECMO are provided for better understanding of the process. Against the results of the only multicentre randomised trial of ECMO versus conservative treatment, the presentation will focus on (potential) risk factors for cerebral haemorrhage and ischemia during ECMO treatment.

Results and conclusion Although neonatal ECMO treatment shows improved outcome compared to conservative treatment in cases of severe respiratory insufficiency, it is related to disturbances in various aspects of neurodevelopmental outcome. Risk factors for cerebral damage are either related to the patient’s disease, ECMO treatment itself, or a combination of both.

It is of on-going importance to further understand pathophysiological mechanisms resulting in cerebral haemorrhage and ischemia due to ECMO and to develop neuroprotective strategies and approaches.