Limb ischemia 
Major vascular complications are common in post-cardiotomy patients after ECMO support mainly due to reduced blood flow which may occur due to various factors such as large cannula (>20 Fr) occluding the vessel, female gender, and peripheral vascular disease like atherosclerosis. Limb amputation may also be necessary in severe and lifesaving cases.
Reperfusion injuries may then occur when blood flow is increased, which may result in rhabdomyolysis, acute kidney injury, multi-organ failure and systemic inflammatory response . Insertion of cannula under fluoroscopic guidance can help significantly reduce limb ischaemia. Frequent monitoring of cannula site will also ensure cannula is not kinked or obstructed by thrombus. A duplex ultrasound can be used to detect blood flow however it is user-dependent and cannot be monitored continuously. Flow monitoring through the ECMO shunt could be feasible for continuous monitoring. Graft interposition can also be done to eliminate limb ischemia.