**2.5 Explantation**

ECLS is a lifesaver for patients with compromised cardiopulmonary function; however, it may instigate life-threatening complications and the incidence of complications increases with increase in duration of the ECLS. Yoe *et al.* found the duration of ECLS more than 7 days is a factor associated with the development of limb ischemia [23]. Therefore, weaning of ECLS should begin with recovery of vital organ function with the aim of its explantation as soon as possible. Extra caution is mandated during weaning of patients with the DPC, as the decrease in total ECLS flow decreases DPC flow that may lead to inadequate limb perfusion as well as thrombosis of the DPC. In this situation, the DPC flow should be maintained around at least 300 ml/min by applying a gate clamp on the retrograde arterial cannula. Explantation of ECLS at the end of successful weaning should be performed as an elective case in the operation theatre. The vessels are exposed and controlled with slings before removal of cannulas. Embolectomy is attempted multiple times with balloon tip catheters till satisfactory retro and antegrade blood flow is achieved. The artery is then repaired with or without a patch or an interposition graft to maintain its original calibre without flow limitation. The limb is monitored for at least 48 hours following ECLS explantation for any signs of residual or fresh ischemia.
