Limb ischaemia is a serious complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This systematic review and meta-analysis of 17 studies involving 2,812 adults found a pooled limb ischaemia incidence of 16.9%. Peripheral arterial disease, unsuccessful percutaneous cannulation, and shorter patient height were significant risk factors, underscoring the need for early risk identification and preventive strategies in ECMO care.