In recent decades, the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increased. In acute cardiogenic shock, VA-ECMO implantation can serve as a bridging solution to facilitate recovery, provide durable mechanical support, or enable heart transplantation. Additionally, VA-ECMO can be used during resuscitation and extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to be a viable therapy option in several studies (5). Lower limb ischemia is a well-recognized complication in patients treated with VA-ECMO. Placement of a distal perfusion catheter (DPC) may prevent this severe complication. However, implantation of percutaneous DPC can be highly challenging in emergency situations or even under CPR. Here we present a novel retrograde DPC implantation technique for distal limb perfusion in patients with VA-ECMO.