When a patient is put on ECMO, the priority is clear: stabilize and save their life. But survival is only the beginning. What happens next – quality of life, mobility, independence – relates to something else entirely: limb preservation during ECMO.

Distal limb ischemia is a known complication, especially with femoral cannulation. Even when you’re doing everything right, loss of perfusion can sneak in quietly and escalate quickly.

And while DPCs are a helpful tool, flow through them is rarely measured directly. That’s where the risk lies. Too little flow? You’re facing ischemia. Too much? Now hyperperfusion’s on the table.

It’s a delicate balance, as you know. And without actual flow data, it's a lot of guesswork.

The Risk of Acute Lower Limb Ischemia During ECMO

For patients on ECMO, especially those undergoing femoral cannulation, blood flow to the lower limb can be compromised.

You can correct a problem you can't quantify... but can you correct it in time? Quantitative flow measurement alerts you the moment flow drops, allowing you to intervene before it becomes a threat to the patient's health.

NIRS Alone Doesn’t Tell the Whole Story About Acute Limb Ischemia

Many teams rely on near-infrared spectroscopy (NIRS) to monitor for ischemia. And while NIRS is a valuable tool for tracking tissue oxygenation, it doesn’t measure flow. You can’t correct a problem you can’t quantify.

In fact, ELSO guidelines recommend both tissue saturation monitoring and actual flow measurement. Specifically:

• Flow through the DPC should be at least 100 mL/min
• Tissue saturation should remain above 50%, ideally 60%
• Less than 20% difference in saturation between the two limbs

A Better Way To Monitor Distal Perfusion

The good news is that real-time flow monitoring is not only possible, but it’s also easy to implement. And it doesn’t require modifying your ECMO circuit.

Transonic’s AureFlo and Optima Flowmeter make it easy to monitor DPC flow in real time. The AureFlo sensor clamps directly onto standard 1/8" perfusion tubing and integrates seamlessly into existing ECMO setups, giving your team beat-to-beat, quantitative flow data they can use.

These tools support fast, informed decisions whether you're at the bedside, in the OR, or monitoring post-op in the ICU.

Because when you have access to the right data, you can protect the limb while you’re saving a life.

Learn more about flow measurement for distal limb perfusion.