Extracorporeal membrane oxygenation (ECMO) has been adopted to support patients with acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management. In the presence of pulmonary embolism, mesenteric ischemia (MI) can present as a life-threatening disorder that leads to intestinal ischemia. Due to the nature and acuity of these conditions, determining adequate perfusion upon surgical intervention is challenging for the operating surgeon, especially in the presence of cardiogenic shock despite ECMO support. Indocyanine green fluorescent angiography (ICG-FA) has proven to be useful for real-time vascular perfusion assessment, which may potentially decrease the rate of development of perfusion-related complications. The case report here-in presented, breaks the paradigm of performing noncardiac surgical procedures on ECMO support via a pioneering visual aid technique. Learning objective Indocyanine green fluorescent angiography (ICG-FA) is a promising visual trans-operatory technique providing real-time feedback for the adequate identification and assessment of target tissue/organs. The high morbidity and mortality rates associated to MI and CS – particularly when concomitantly present – hinders salvage surgical therapy. The use of acute ECMO provides stabilization yet lacks any curative solutions. This case report highlights the importance of adequate surgical intervention under extracorporeal life support in the presence of both CS and MI. To the authors’ knowledge, said approach has never been attempted, yet trails a promising therapy for the improvement of associated mortality rates.