In recent years, Extracorporeal Membrane Oxygenation (ECMO) has been increasingly used in the treatment of acute respiratory and circulatory failure cases where conventional therapies have proven ineffective. According to the 2023 global data from the ELSO organization, over 202,341 patients have received ECMO-assisted treatment.

With advancements in lung transplant surgical techniques and perioperative management, the long-term survival rates of recipients have significantly improved. The maturity and development of ECMO have transformed many previous absolute contraindications for lung transplant surgery into relative contraindications, playing a crucial bridging and supportive role. Nowadays, an increasing number of lung transplant patients receive ECMO assistance during the perioperative period. For patients awaiting lung transplantation due to respiratory failure, ECMO can partially or completely replace autologous lung function, serving as a bridge during the waiting period. In many lung transplant centers, intraoperative ECMO support has replaced extracorporeal circulation as the preferred strategy for respiratory circulation support during lung transplant surgery. VA-ECMO can provide comprehensive respiratory and circulatory support, ensuring the smooth progress of the transplantation surgery. When primary graft dysfunction (PGD) or acute respiratory failure occurs after transplantation, ECMO can provide oxygenation support while waiting for the transplanted lung function to recover or for a retransplantation. Currently, it is reported that 30-40% of lung transplant patients in the perioperative period require ECMO support, and this proportion is steadily increasing.

In the field of thoracic surgery, when conventional methods fail to provide normal oxygenation for complex airway surgery or when airway treatment is needed under endoscopy, ECMO can offer an alternative form of respiratory support, complementing high-frequency ventilation, thus ensuring safe airway surgery. Furthermore, in cases of severe cardiopulmonary complications after thoracic surgery, such as severe lung infections, severe ARDS, acute myocardial infarction, acute pulmonary embolism, etc., ECMO can provide suitable respiratory and circulatory support.

As the largest center for the diagnosis and treatment of pulmonary diseases in the country, ECMO is recognized as a reflection of comprehensive critical care capabilities. The success of ECMO depends not only on the treatment of the primary disease, extracardiac organ function, immune status, and prevention and management of complications, but also on the cooperation, teamwork, and management capabilities of the ECMO team. Currently, our hospital has five sets of advanced ECMO equipment. We can independently perform various ECMO modes, including VA-ECMO, VV-ECMO, and VAV-ECMO.

In 2022, our hospital pioneered the One-site single-lumen double-cavity venous cannula technique, which not only meets the basic requirements for VV-ECMO but also offers significant advantages when applied to patients awaiting lung transplantation. Due to the absence of femoral vein cannulation, patients can be positioned more flexibly, reducing sedation requirements and facilitating the transition to awake ECMO. This approach promotes physiotherapy and early mobilization, facilitates clinical decision optimization by doctors, and significantly reduces the risk of patient transfer for ECMO; having only one cannulation site also reduces the risk of infection at the cannulation site during long-term maintenance of VV-ECMO (adult infection rate: double-cavity 3.4% vs. single-cavity 24%); the design of double-cavity cannulation physically separates the drainage and return locations, greatly reducing recirculation and improving ECMO efficiency. Literature reports indicate recirculation rates of 1%-3% for double-cavity cannulas and 5%-19% for single-cavity cannulas. For patients requiring prolonged support, especially for lung transplant recipients who need bridge ECMO support, this technique is highly advantageous.

The comprehensive implementation of ECMO technology in Shanghai Pulmonary Hospital not only benefits the development of the lung transplant discipline but also nurtures a professional ECMO team, capable of rapidly and effectively establishing ECMO support. Currently, our hospital has 18 medical personnel with ECMO specialized training certificates. In recent years, the hospital has performed over 30 ECMO transitions annually, with a high success rate of 86.9% for ECMO weaning. The all-around development of ECMO technology not only safeguards thoracic surgery at our hospital but is also the ultimate lifeline for patients with intractable respiratory failure who are intubated and remain unresponsive to mechanical ventilation.