Table 1. Cannulation strategies for specific pre-lung transplant disease states.

Mechanism of failure	Cannulation approach	ECMO parameters
Hypercapnic respiratory failure
Cystic fibrosis, COPD	Small bore bicaval	Goal ECMO flow of 2.5 to 3.5 L/min
		Titrate sweep for goal PaCO2 of 35–45 with no resting dyspnea
Hypoxic respiratory failure
Idiopathic pulmonary fibrosis	Large bore bicaval or femoral-IJ	Goal ECMO flows of 3.5 to 5 L/min
		May require HFNC to maintain SpO2 >90%
Right ventricular failure
Group 1 pulmonary hypertension	Peripheral VA ECMO	Goal ECMO flows of 2.5 to 3.5 L/min to offload the right ventricle
Group 3 pulmonary hypertension	Large bore bicaval with atrial septostomy or RV bypass ECMO	Goal ECMO flows of >3.5 L/min or more as needed to maintain SpO2 >90%

ECMO, extracorporeal membrane oxygenation; COPD, chronic obstructive lung disease; IJ, internal jugular; HFNC, high flow nasal cannula; VA, venoarterial.