Abstract: Extracorporeal membrane oxygenation (ECMO) is a core technology in extracorporeal life support, with membrane-based artificial lungs playing a crucial role in acute respiratory failure management and cardiopulmonary surgery. However, current membrane-based artificial lungs face challenges such as low gas transfer efficiency, poor gas selectivity, and poor blood compatibility. This review summarizes recent advancements in overcoming these challenges, focusing on the material fabrication and structural regulation of artificial lung membrane materials, as well as surface modification strategies. The application of green diluents and binary diluent systems in thermally induced phase separation technology is analyzed, along with the advantages of biomimetic coatings and multifunctional structural designs for improving gas selectivity and blood compatibility. Additionally, this review highlights key challenges, including the limited blood compatibility of membrane-based artificial lungs during prolonged use and the trade-off between gas transport and anti-leakage performance. A multifunctional integration approach is proposed, combining material modification and structural optimization to overcome these limitations. Finally, the future development of membrane-based artificial lungs is discussed, with a focus on miniaturization, efficiency enhancement, and sustainability. This review provides a systematic reference for the high-performance development and clinical application of membrane-based artificial lungs.