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Historically, VV ECMO was limited in this population due to small vessel size, anatomical constraints, and technical challenges in achieving stable high-flow access. Recent advancements, including the development of the Crescent Right-Atrial (RA) dual-lumen cannula and increasing adoption of multisite cannulation strategies, have significantly expanded VV ECMO feasibility in neonates and small infants. Institutional experiences now support the safety and efficacy of VV ECMO in this vulnerable group when performed with skilled teams and advanced imaging guidance. This review synthesizes current evidence, highlights evolving cannulation techniques, and presents innovative solutions aimed at improving outcomes for infants and children under 10\u00a0kg requiring VV ECMO.<\/jats:p>","DOI":"10.1177\/02676591251379622","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T18:17:18Z","timestamp":1757614638000},"page":"568-575","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["VV ECMO cannulation in infants and children under 10\u00a0kg: Evolving strategies, outcomes, and innovations"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9774-3525","authenticated-orcid":false,"given":"Jana","family":"Assy","sequence":"first","affiliation":[{"name":"University Hospital of Liege"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3850-8769","authenticated-orcid":false,"given":"Issam","family":"El Rassi","sequence":"additional","affiliation":[{"name":"Al Jalila Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-016-0121-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-024-02002-5"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2020.03.014"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-022-02187-5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000103"},{"key":"e_1_3_3_7_2","first-page":"125","volume-title":"The ELSO red book","author":"Wild KT","year":"2022","unstructured":"Wild KT, Chapman RL, Davis CF, et al. 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