In lung transplantation, the use of intraoperative mechanical support, particularly cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), has evolved over time due to their respective advantages and disadvantages. While CPB was traditionally preferred for its full hemodynamic support, it poses risks like systemic inflammation and coagulopathy; ECMO, on the other hand, offers many benefits of CPB with fewer risks, leading to better outcomes such as reduced primary graft dysfunction and overall improved survival, suggesting its potential as a standard protocol in lung transplants.