Background: After weaning of extracorporeal membrane oxygenation (ECMO) support, removal of ECMO cannulas is traditionally by open surgical repair (OSR). Advancement of percutaneous vascular closure devices (VCD) presents an alternative to OSR of the femoral vessels with potential reduction in duration of surgery, hospital length of stay and the incidence of wound complications. Methods: A systematic review of Medline and Embase databases was conducted. The primary endpoint was rate of post-procedural complications, namely wound infection and limb ischaemia. The secondary endpoint was in-hospital mortality. Results: A total of 5 retrospective studies, with a total of 486 patients (64% male, n=311) were included in the systematic review and meta-analysis, of which 251 underwent VCD decannulation. Pooled analysis demonstrated that percutaneous closure with VCD is at significantly lower risk of overall complications than surgical repair (OR 3.20; 95% CI 1.84-5.56; P = 0.003), particularly wound infections (OR 5.68; 95% CI 2.26-14.29; P = 0.0002). There was no significant difference between the cohorts in in-hospital mortality. Conclusion: Percutaneous decannulation of ECMO offers a significantly reduced risk of complications. Vascular surgeons in ECMO centres should be trained in the deployment of VCD for percutaneous decannulation of ECMO. Future high-quality research is required to better elucidate the potential for reduced hospital length of stay and duration of surgery.