LAUSR

To the Editor: We read with great interest a systematic review published in a recent issue of Critical Care Medicine by Sutter et al (1) examining acute neurologic complications in adult patients on extracorporeal membrane oxygenation (ECMO). The authors included an accompanying proposed algorithm of preventative strategies. We congratulate the authors on their contribution to an area in need of further study. However, we would like to share our experience in managing adult patients with severe respiratory failure on veno-venous ECMO with intracranial hemorrhage (ICH). As a severe respiratory failure centre covering Southern England, we retrieve patients both conventionally and following initiation of ECMO at the referring hospital, performed by a dedicated retrieval team—up to 120 patients/yr. On arrival at our institution, almost all patients undergo CT imaging, Innovation, University of Michigan, Ann Arbor, MI; Katherine E. Bates, MD, Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI; Marissa A. Brunetti, MD, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; David S. Cooper, MD, MPH, Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Jessica Lehrich, MS, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Kshitij P. Mistry, MD, MS, Department of Cardiology, Boston Children’s Hospital, Boston, MA; Sara K. Pasquali, MD, MPH, Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI; Andrew Y. Shin, MD, Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; Sarah Tabbutt, MD, PhD, Division of Critical Care Medicine, Department of Pediatrics, Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA; Michael Gaies, MD, MPH, MS, Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI