To systematically evaluate the efficacy and safety of Extracorporeal Membrane Oxygenation (ECMO) and Cardiopulmonary Bypass (CPB) in lung transplantation, we searched databases including PubMed, EMbase, The Cochrane Library, Web of Science, and CNKI. We used Review Manager V5.3 software for meta-analysis of the literature. A total of 10 retrospective studies were included, covering 1158 clinical patients (535 in the ECMO group and 623 in the CPB group). Compared to CPB, ECMO showed less intraoperative platelet demand [MD = −3.32, 95 % CI (−3.58, −3.06), P < 0.0001]; shorter ICU stay times [MD = −4.33, 95 % CI (−7.76, −0.90), P = 0.01]; and lower incidences of complications such as tracheotomy [OR = 0.52, 95 % CI (0.33, 0.81), P = 0.004], renal failure [OR = 0.53, 95 % CI (0.36, 0.77), P = 0.0009], and secondary surgeries [OR = 0.27, 95 % CI (0.16, 0.46), P < 0.00001], all statistically significant. However, no significant differences were observed in postoperative mortality rates (at 1 month, 3 months, and 1 year) or other transfusion requirements between the two groups. Our analysis suggests that compared to CPB (Cardiopulmonary Bypass), ECMO (Extracorporeal Membrane Oxygenation) can reduce ICU stay and intraoperative platelet requirements, while also decreasing the incidence of tracheostomy, renal failure, and secondary surgeries. Although ECMO shows advantages in several clinical indicators, its long-term postoperative survival rate is similar to that of CPB. When choosing ECMO as a support technology for lung transplantation, various factors should be considered comprehensively. More research is needed to further clarify which patient populations benefit from which type of extracorporeal support technology.