Perioperative Extracorporeal Membrane Oxygenation Use in Lung Transplantation: Analysis of Outcomes and Future...

Extracorporeal membrane oxygenation (ECMO) has emerged as a critical intervention in the management of patients with end-stage lung disease undergoing lung transplantation. Its applications span pretransplant bridging, intraoperative support, and postoperative management, with the overarching goal of stabilizing critically ill patients, optimizing physiological reserve, and improving post-transplant outcomes. Careful patient selection, multidisciplinary evaluation, and individualized cannulation strategies are essential to maximize benefits while minimizing complications. Ethical challenges-including resource allocation, equitable access to organs, informed consent, and management of "bridge to nowhere" scenarios-remain central considerations, particularly in resource-constrained settings. Future directions emphasize integration of personalized, data-driven approaches, biomarker-guided risk stratification, artificial intelligence for outcome prediction, and advanced ECMO technologies such as portable devices and improved circuit biocompatibility. Coordinated clinical and ethical frameworks are required to ensure ECMO is applied effectively, safely, and equitably across the lung transplantation continuum.