Transthoracic echocardiography is an essential tool for the management of venoarterial extracorporeal membrane oxygenation (VA-ECMO). Its ease of access makes it ideally suited for routine daily bedside assessments, which are essential for adjusting ECMO flow, detecting ECMO-related complications, evaluating the need for venting devices, and monitoring patient recovery. If transthoracic imaging is not feasible or the images are suboptimal, a transesophageal echocardiography should be performed. We aimed to propose a systematic echocardiographic approach using a nine-point checklist to address the key challenges faced by physicians managing VA-ECMO patients.