In this article by Almajed et al. [ ], the authors describe a very high incidence of ischemic (8.2 %) and hemorrhagic (6.6 %) stroke in the setting of V-A ECMO (combined stroke rate of 14.8 %). Indeed, serious complications during V-A ECMO, including stroke, remain a major limitation of this potentially life-saving technology [ ]. Life-threatening complications include critical limb ischemia (∼10–20 %), ongoing cardiogenic shock and failure to be weaned from ECMO, and a high incidence of stroke as described in the current study [ , , ].