Technique
Under fluoroscopy guidance in the operating room, the left subclavian was percutaneously accessed with Seldinger’s technique. An Amplatz Super Stiff guidewire (0.035 inch ⫻ 260 cm; Boston Scientific, Natick, MA) was positioned into the right atrium and inferior vena cava. After serial dilation, the 28 French CrescentTM Jugular Dual Lumen Catheter (Medtronic, Minneapolis, Minnesota) was advanced under fluoroscopic and transesophageal echocardiographic guidance with the infusion jet facing the tricuspid valve. Placement of the CrescentTM Catheter was confirmed while maintaining full ECMO support from the previously circuit to ensure patient stability throughout the procedure (Figure 1) . Once positioned, the previous cannulas were clamped and removed after properly splicing the new dual lumen cannula to the ECMO circuit (Figure 2A and B) .
Since the conversion of cannulation strategies, the patient continued to improve. Her remaining BPF have healed and her activity level continues to improve each day.