This study evaluates the impact of extracorporeal life support (ECLS) as a bridge to lung transplantation (BTT) for patients with idiopathic pulmonary arterial hypertension (iPAH). A comparison between two cohorts (1997–2005 and 2006–2010) shows that ECLS significantly reduced waiting list mortality (from 22% to 0%) while slightly increasing ICU stay. The findings suggest that aggressive ECLS management can improve survival rates for iPAH patients awaiting lung transplants.