Introduction: The use of perioperative Extracorporeal Membrane Oxygenation (ECMO) in lung transplantation (LTx) has increase along the years, with multiple well established indications and benefits. In this study, we aim to report the use of intraoperative ECMO at our institution and the employment of hybrid cannulation (femoral vein-aorta configuration).

Methods: Retrospective study at a single center (Instituto do Coração - HCFMUSP / Brazil). The data collection used the REDCap database regarding LTx from 2011 to 2021.

Results: It was performed 291 LTx from 2011 to 2021 and 25  (8,6%) utilized intraoperative ECMO support. ECMO support AS Bridge to LTX was used in 5 cases and extended to intraoperative support.  Programmed ECMO was used in 10 patients. Central VA cannulation was implemented on 6 patients; 4 patients undergone to hybrid cannulation; 4 patients on peripheral VA-ECMO and 1 on peripheral VV-ECMO. In the group of patients on central ECMO, 4 were successfully decanullated. In the hybrid cannulation group, all the patients were successfully decanullated at the end of the LTx. The mean time of central cannulation was 7.2 days and 11,2 days in the hybrid cannulation group. When LTx occurred using central VA-ECMO , the mean Intensive Care Unit (ICU) stay was 23.3 days and 34 days when hybrid cannulation was used. The total hospital stay was 41.5 on central ECMO and 52.7 on hybrid. When regarding hospital discharge and long therm survival, central cannulation presented a 83.3% survival-rate and hybrid cannulation presented 75%.

Conclusion: Intraoperative ECMO support is well established on LTx, despite the low rate of utilization at our center. The use of hybrid cannulation may offer an alternative when supporting critical patients, with less central manipulation and allowing more easily the transition to VV-ECMO at the end of LTx when required.