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Peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) creates a retrograde flow along the aorta competing with the left ventricle (LV) in the so-called ‘mixing zone’ (MZ). Detecting it is essential to understand which of the LV or the ECMO flow perfuses the upper body – particularly the brain and the coronary arteries – in case of differential hypoxemia (DH).