We describe the adoption of extracorporeal circulation (ECC) as temporary pulmonary support in a patient operated on for a broncho-pleural fistula. Complex thoracic surgical procedures can require one-lung ventilation with double-lumen or selective bronchial tubes. Intraoperative tube displacement can cause severe desaturation and hypoxia, finally resulting in severe cerebral or multiorgan damages. Cardiopulmonary bypass, being able to temporarily take over the gas exchange function of the lung, is the only chance to support pulmonary function in cases such as this one. We suggest performing complex thoracic surgical procedures in centers with the availability and experience of ECC techniques.