PURPOSE: Intraoperative extracorporeal membrane oxygenation (ECMO) as the primary means of tissue oxygenation during pediatric lung transplantation has been increasingly used as an alternative to cardiopulmonary bypass (CPB). Current literature in adults undergoing lung transplantation suggest a benefit of ECMO over CPB. However, there is limited data on the outcomes in children. We sought to determine outcomes of intraoperative ECMO versus CPB during pediatric lung transplantation at our institution. METHODS: We retrospectively reviewed the records of pediatric patients (<18 years of age at surgery) who underwent bilateral lung transplantation from 2014 to 2019. The primary outcome was mortality at 30 days, 6 months, and 1 year post-transplant. We also collected data on demographics, preoperative requirements (ECMO support, mechanical ventilation, tracheostomy, and gastrostomy tube), prior operations, surgical times, postoperative support (inotropes, duration of oxygen support, and transfusions), postoperative complications, hospital length of stay, readmissions, and reoperations. RESULTS: Of the 35 children who underwent lung transplantation over this period, 14 (40.0%) were transplanted on ECMO support while 21 (60.0%) were transplanted on CPB. There was no statistically significant difference in mortality at 30 days (0.0% ECMO vs 4.8 % CPB), 6 months (0.0% ECMO vs 11.1% CPB), or at 1 year post-transplant (14.3% ECMO vs 33.3% CPB). Other analyzed variables did not differ significantly (Table 1). CONCLUSION: Although the use of ECMO as a primary means of tissue oxygenation in adult lung transplantation has shown a benefit when compared to CPB, this study shows no difference in outcomes within intraoperative and postoperative variables during pediatric lung transplantation. This data is representative of transplants within a single high-volume institution; data from additional institutions may strengthen these observations.