Central versus peripheral veno-arterial extracorporeal membrane oxygenation during lung transplantation: a systematic review and meta-analysis

Introduction: The use of extracorporeal membrane oxygenation (ECMO) during lung transplantation has progressively expanded and, in many centers, replaced conventional cardiopulmonary bypass. However, it remains unclear whether central or peripheral veno-arterial (VA) ECMO provides superior postoperative outcomes. This study aimed to compare central VA-ECMO (cVA-ECMO) and peripheral VA-ECMO (pVA-ECMO) during lung transplantation, with a focus on survival, primary graft dysfunction grade 3 (PGD3), postoperative ECMO support, and postoperative morbidity. Methods: Three databases were assessed through November 2025. Five retrospective observational studies including 866 patients were included. Overall survival was analyzed using reconstructed individual patient data derived from Kaplan-Meier curves. Random-effects models were applied for all pooled analyses. Results: There was no significant difference in overall survival (HR 1.224, p=0.13) and in PGD3 at 72 h incidence (OR 1.55; p=0.26) between cVA-ECMO and pVA-ECMO. However, pVA-ECMO was associated with a higher requirement for postoperative ECMO use (OR 6.05; p=0.04), longer duration of extracorporeal support (MD +1.61 days; p=0.01), prolonged mechanical ventilation (MD +2.73 days; p