Conventional extracorporeal membrane oxygenation and mechanical ventilation have both been identified as significant risk factors for post–lung transplant mortality when applied as a bridge to lung transplantation. We have previously described the successful use of the extracorporeal membrane ventilator Novalung as a bridge to lung transplantation in patients with severe hypercapnia and respiratory acidosis. In this setting the Novalung was connected in the arterio-venous mode without support of a mechanical blood pump. However, in patients with predominant hypoxemia, this pumpless mode does not achieve sufficient blood oxygenation due to limited blood flow. Thus, such patients require pump-driven support. Here we describe our initial experience with the Novalung extracorporeal membrane ventilator, which was originally designed for pumpless carbon dioxide removal, as a bridge to lung transplantation in patients with ventilator-refractory hypoxemia in the veno-venous pump-driven mode.