IN PATIENTS UNDERGOING bilateral lung transplant (BLT), the use of planned intra- and postoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasing. It has become the standard practice in many institutions following the growing literature reporting favorable outcomes.^1-3 In contrast, operating room (OR) extubation after BLT, also referred to as immediate extubation, remains infrequent.⁴ The current authors present a patient who underwent BLT on VA-ECMO and was extubated in the OR, discuss considerations for successful OR extubation, and argue that planned intra- and postoperative VA-ECMO for BLT offers an opportunity for safe and effective OR extubation in select patients.