Extracorporeal membrane oxygenation is increasingly used in the early postoperative period after lung transplantation, mainly to support patients with primary graft dysfunction and severe right ventricular failure. Recipients with high risk, particularly those with pulmonary arterial hypertension, may benefit from prophylactic extracorporeal membrane oxygenation to promote controlled reperfusion and reduce early allograft injury. This review synthesizes current evidence on indications for postoperative extracorporeal membrane oxygenation, optimal selection between venovenous and venoarterial support, and cannulation strategies tailored to cardiopulmonary physiology. Key challenges, including recirculation, vascular complications, infection risk, and altered pharmacokinetics, are discussed along with methods to detect and mitigate them. Emphasis is placed on the critical care nurse’s integral role in ensuring the safety and success of extracorporeal membrane oxygenation, coordinating multidisciplinary care, identifying complications early, and applying evidence-based management to support allograft recovery and improve patient outcomes.
