Background:Percutaneous Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has been reported to improve survival in patients with cardiogenic shock or cardiac arrest. The femoral artery is used for arterial access. Limb ischemia of cannulation site which evokes lower-limb impairment (LLI) is one of the most serious complications. Incidence of limb ischemia is generally 6.5% in Japanese investigation. Recently, the overall survival rate has been increased after VA-ECMO, but LLI impede rehabilitation in society in survival patients. Purpose: We have investigated LLI at acute phase and clinical outcomes at the recovery phase (mean follow-up period: 30.4 month) in survival patients undergoing VAECMO. Methods: A cohort of 31 patients (58.9± 16.1 years old, 87% male) who underwent VA-ECMO in our hospital was retrospectively reviewed from October 2008 to August 2014. Soon after patients got stable circulation without any of life-support system and high dose catecholamine, their rehabilitation started. The rehabilitation goal was return society, and that program was mainly daily activity and gait training with care of cardiac function and arterial access complications. Results: In baseline characteristics, the patients with VAECMO included 15 acute myocardial infarction, 1 stent thrombosis, 5 ventricular fibrillation, 4 pulmonary thromboembolism, 2 fulminant myocarditis, 1 drug overdose, and 1 cardiac trauma, 1 pericarditis, 1 myxedema. Mean driving time of VA-ECMO was 45.0± 37.9 hour. The rate of weaning VA-ECMO was 45.2% (14/31), survival at discharge 35.5% (11/31), full-recovered consciousness 25.8% (8/31), and rehabilitation in society 19.4% (6/31). The incidence of LLI was 62.5% (5/8) in patients with full-recovered consciousness. At acute phase, the 3 patients had LLI in cannulated limb: 1 common peroneal paralysis, and 2 femoral neuropathies, while the 2 patients had LLI bilaterally: 1 paraplegia, 1 bilateral common peroneal paralysis. At recovery phase, 1 patient with femoral neuropathy had returned to society without gait disturbance and 4 patients remained LLI regardless of rehabilitation. They needed some walk auxiliary equipment or wheelchair. Conclusion(s): More than half of the patients who underwent VA-ECMO and recovered consciousness remained LLI. LLI did not occur only VA-ECMO access limb but also both limbs which were fatal and difficult to return society. Implications: Survival patients after VA-ECMO should be considered LLI. We must constantly assess total physical ability in particular patient recovered from cardiogenic shock or cardiac arrest.