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Extracorporeal membrane oxygenation (ECMO) is a temporary artificial support in cases of ineffective oxygenation due to severe lung dysfunction, severe circulatory failure, or both. Lung transplantation (LTx) has become a life-saving procedure for patients suffering from end-stage lung diseases. Its indications have progressively broadened over time and outcome has steadily improved. Unfortunately, still a considerable number of patients die on the waiting list before transplantation. Moreover, postoperative complications can be life threatening. The present article reviews the published literature about the implementation of ECMO in the perioperative care of the LTx patient. This progressively developed technique of vital support is a feasible therapeutic option in cases of terminal respiratory failure before transplant, thus being a bridge to it, and in the management of severe immediate postoperative complications. First, we present a historic view of the role of ECMO support in acute respiratory failure, with critical discussion of the only 3 published clinical trials on ECMO in adult patients. Then, the interactions between ECMO and LTx are examined. Larger case series about ECMO bridging to LTx are reviewed, with particular focus on the awake ECMO strategy. Finally, evidence for ECMO support in the intraoperative and postoperative care of LTx is discussed.