Objective To investigate the safety and effectiveness of the ProGlide-based post-closure technique in awake veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation.Methods The clinical outcomes of patients who received awake VA-ECMO treatment and removed from the machine in our hospital from Jan.2017 to Jun.2021 were retrospectively analyzed.The patients were divided into ProGlide-based post-closure technique group (ProGlide group) and surgical repair group according to the vascular closure method used.All-cause in-hospital mortality,procedure time of arterial closure decannulation,bleeding-related events,and vascular-related complications within 30 d were analyzed.Results A total of 35 patients were eventually enrolled,including 21(60.0%) with ProGlide-based post-closure technique and 14(40.0%) with surgical repair technique.There were 21 males (60.0%) and 14 females (40.0%) with a mean age of (49.20±10.52) years old.The median time of VA-ECMO support was 10.0(8.0,12.0) d,and the all-cause in-hospital mortality was 11.4%(4/35).Multivariate logistic regression analysis showed that after adjusting for age and gender,there was no significant difference in all-cause in-hospital mortality between the 2 groups (odds ratio[OR]=0.78,95% confidence interval[CI]0.09-6.89,P=0.826) at the primary end point.The secondary end point showed the ProGlide group had less procedure time (β=14.14,95%CI 7.22-21.05,P<0.01) and shorter intensive care unit (ICU) length of stay after decannulation (β=2.11,95% CI 0.20-4.02,P=0.032).There were no major bleeding events or major vascular-related complications within 30 d between the 2 groups.The ProGlide group had lower incidence of minor bleeding events or minor vascular-related complications within 30 d than the surgical repair group (OR=0.13,95%CI 0.02-0.88,P=0.036;OR=0.05,95%CI 0.00-0.59,P=0.018).The critical care pain observation tool (CPOT) score of the patients in the ProGlide group was significantly lower than that in the surgical repair group (β=1.26,95%CI 0.37-2.14,P=0.007).The need for remifentanil for arterial suturing was significantly increased in the surgical repair group (OR=0.06,95%CI 0.01-0.36,P=0.002).Conclusion ProGlide-based post-closure technique is safe and effective in the process of awake VA-ECMO decannulation.Compared with surgical repair technique,it has the advantages of shorter procedure time,less bleeding and vascular-related complications,and less pain for patients,and it has a certain role in promoting rapid recovery of patients.