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Objective To investigate the success rate, complications and influencing factors of extracorporeal membrane oxygenation (ECMO) puncture and catheterization under ultrasound guidance. Methods Clinical cases of veno-arterial ECMO were collected. The success rate and incidence of complications of ultrasound-guided percutaneous catheterization were analyzed. Meantime, gender, age, cardiac function (ejection fraction (EF) < 30%/EF 30%), target artery diameter (< 5.0 mm/ 5.0 mm), success of one-time puncture, hypertension and other variables were included. Univariate and/or multivariate logistic regression analyses were used to analyze the influencing factors of the overall success rate and complications of catheterization in extracorporeal cardiopulmonary resuscitation (ECPR) patients (ECPR group) and non-ECPR patients (non-ECPR group). Results 65 cases of veno-arterial ECMO were included in the study, with an average age of(49.3 ± 18.2) years. 23 cases were assigned in the ECPR group and 42 cases in the non-ECPR group. The overall success rate of ultrasound-guided ECMO catheterization was 86%, 78% in the ECPR group and 91 % in non-ECPR group. 13 cases developed hematoma and 5 cases of distal limb ischemia after puncture.Logistic regression analyses showed that the target artery diameter and the success of one-time puncture were the influencing factors for the success rate of overall puncture and catheterization, and the success of one-time puncture was also the influencing factor for the incidence rate of hematoma (all P < 0.05). In subgroup analysis, the diameter of target artery was found to be a factor affecting the success rate of puncture and catheterization in the ECPR group (P < 0.05), whereas no statistically significant factor was found in the non-ECPR group (all P > 0.05). Conclusions Percutaneous ultrasound-guided ECMO catheterization has a high success rate and safety. For non-ECPR patients and those with target artery diameter of 5 mm, percutaneous ultrasound-guided ECMO catheterization is the optimal option. Successful one-time puncture should be guaranteed, which can not only improve the success rate of final puncture and catheterization, but also reduce the incidence of hematoma. [ABSTRACT FROM AUTHOR]