Evidence-based neurological monitoring in newborns undergoing extracorporeal membrane oxygenation applied to nursing care: a scoping review

To map the available evidence on neurological monitoring in neonatal ECMO and to derive from it an evidence-based nursing-care model that translates monitoring findings into concrete bedside nursing actions across the ECMO trajectory. A JBI scoping review (PRISMA-ScR) searched PubMed, BVS, ScienceDirect, Scopus, Web of Science and grey literature (February–April 2025). Included: studies in English, Spanish or Portuguese (1991–2025) on neuromonitoring in term or late-preterm neonates (≤28 days) on ECMO; two reviewers screened and extracted data independently. Twenty studies were included: 8 reviews, 7 observational, 2 pilot, 2 case series, 1 guideline. Reported modalities: cranial ultrasound (40 %), aEEG (40 %), EEG (35 %), NIRS (35 %), brain MRI (25 %), head CT (20 %), transcranial Doppler/biomarkers (10 %). Intracranial haemorrhage, ischaemic injury and seizures dominated; recurrent risk factors were prematurity, carotid cannulation, coagulopathy, venoarterial configuration and low birthweight. Only two studies described nursing care. The proposed model is organised by the three ECMO phases (pre-cannulation, during ECMO and post-decannulation), each specifying the clinical objective, core monitoring actions, nursing-led tasks and escalation steps. The findings suggest increasing adoption of multimodal bedside neuromonitoring in neonatal ECMO; nursing-specific evidence remains underreported, and several elements of the proposed model rest on extrapolation rather than direct nursing evidence.