Incidence and Risk Factors of Limb Ischaemia in Adult Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

ABSTRACT Background Limb ischaemia is a serious and potentially limb‐threatening vascular complication associated with veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO). However, substantial heterogeneity has been observed in the reported incidence rates and identified risk factors among published studies. Aim To systematically evaluate the incidence and risk factors of limb ischaemia among patients receiving V‐A ECMO. Study Design PubMed, Web of Science, Embase, Cochrane Library and Scopus were systematically searched from inception to 21 June 2025. Data regarding the incidence of limb ischaemia and associated risk factors among V‐A ECMO patients were extracted. The meta‐analysis was conducted using Stata software. Results Seventeen studies involving 2812 participants were included. The pooled incidence of limb ischaemia among V‐A ECMO patients was 16.9% (95% confidence interval [CI]: 12.6%–21.3%; p effect < 0.001; I 2 = 91.3%). Significant risk factors included peripheral arterial disease (PAD) (odds ratio [OR] = 6.12; 95% CI: 1.22–30.71; p effect = 0.028; I 2 = 70.1%) and unsuccessful percutaneous cannulation (OR = 3.72; 95% CI: 1.90–7.28; p effect < 0.001; I 2 = 0.0%). Additionally, shorter patient height was associated with a higher risk of limb ischaemia (weighted mean difference [WMD] = −2.42 cm; 95% CI: −4.05 to −0.80; p effect = 0.004; I 2 = 13.4%). Conclusions This systematic review and meta‐analysis determined a pooled incidence of limb ischaemia of 16.9% among V‐A ECMO patients and identified two clinically significant risk factors: PAD and unsuccessful percutaneous cannulation. Moreover, an inverse association was observed between patient height and the risk of limb ischaemia. These findings provide robust evidence to support early detection, prevention and optimised management of limb ischaemia in this population. Relevance to Clinical Practice These findings can help clinicians identify high‐risk subgroups, implement targeted monitoring and apply preventive strategies to reduce the incidence of limb ischaemia in patients undergoing V‐A ECMO. Trial Registration: PROSPERO number: CRD420250654349