Infants with refractory respiratory failure who require extracorporeal membrane oxygenation (ECMO) have traditionally been cannulated via the venoarterial route or by using a dual-lumen venovenous cannula in the right internal jugular vein because the femoral vessels are relatively hypoplastic in children who are too young to walk.

Venoarterial cannulation, however, may be associated with higher neurologic complication rates and there has been a global shortage of dual-lumen cannulas after a recent product recall from one of the principal manufacturers.

Positioning a bicaval dual-lumen cannula correctly can also be rendered more difficult in some neonates by the ductus venosus.

Consequently, there are fewer vascular access options in neonatal respiratory failure than in other ECMO patient populations.

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