Intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) is becoming the most common mode of extracorporeal life support (ECLS) in lung transplantation (LTx). We compared rates of primary graft dysfunction (PGD) and other perioperative outcomes in patients who underwent LTx using VA ECMO with either central or peripheral arterial cannulation.

We analyzed bilateral lung transplants using intraoperative VA ECMO which were entered into the multicenter international ECLS in LTx registry between 1/2016 and 8/2024. Our primary outcome included Grade 3 Primary Graft Dysfunction (PGD3) at 48–72 hours. Secondary outcomes included postoperative complications and survival.

There were 501 transplants that met inclusion criteria: 315 in the central group and 186 in the peripheral group. The incidence of PGD3 at 48–72 hours was 26.3% in the central group and 30.1% in the peripheral group (p = 0.42). In the logistic regression analysis, central vs peripheral cannulation was not associated with increased risk of PGD3 (OR 1.64, 95% CI 0.657–4.209, p = 0.294). We found no difference between groups in other graft-related outcomes nor cannulation-related complications including stroke. In the Cox regression analysis, central vs peripheral cannulation was not associated with overall survival (HR 1.5, 95% CI 0.70–3.20, p = 0.298).

The choice of arterial cannulation strategy for intraoperative VA ECMO support did not impact the risk of PGD3, graft- or cannulation-related complications, nor mid-term survival. The decision regarding arterial cannulation site strategy should be tailored to meet patient and procedural needs.