To summarize the mode of intubation and application strategy of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation.

One hundred and seven patients received lung transplantation at the First Affiliated Hospital of Guangzhou Medical University from January 2016 to July 2018, 31 cases of them received ECMO during transplantation and their clinical data were retrospectively analyzed, 20 recipients received double lung transplantation, and 11 recipients received single lung transplantation. Thirty recipients received veno-arterial-ECMO and 1 recipient received veno-veno-arterial-ECMO.

The indication for ECMO during transplantation included 14 cases who couldn′t tolerate one-lung ventilation, 7 of pulmonary arterial hypertension, 3 of intraoperative hemodynamic instability, 1 of intraoperative upper body hypoxia, and 6 of preoperative veno-arterial-ECMO transition. The mode of intubation included 20 cases of central intubation, 5 of femoral vein-femoral artery intubation, 5 of femoral vein-axillary artery intubation, and 1 of femoral vein-jugular vein-ascending aorta intubation. Two patients died of multiple organ failure during 30 days after transplantation. Recipients with central intubation had no obvious complication. Two recipients had bleeding, 1 had intraoperative upper body hypoxia, and 2 had poor wound healing among recipients undergone femoral vein-femoral artery intubation. One recipient underwent bleeding among recipients with femoral vein-axillary artery intubation.The use of ECMO continued into the early period of postoperation in 5 recipients because the function of lung failed to meet the standards.

Intraoperative ECMO use is an important auxiliary way for respiration and circulation, and axillary artery intubation can avoid the complications included distal limb ischemia, thrombosis and upper body hypoperfusion.