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The approach to cannulation in patients requiring extracorporeal membrane oxygenation should be individualized and based on the specific clinical scenario in which the need arises. Adherence to proper techniques of vessel visualization, exposure, and cannulation along with accurate placement of cannula will optimize flows and minimize complications. In most cases an ECMO(Extracorporeal membrane oxygenation) circuit comprises of two large bore cannulae in a veno-venous(VV) or veno-arterial(VA) configuration ( Dual Cannulation ). Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. Experienced centers apply more advanced strategies by cannulation of three large vessels (triple cannulation or hybrid set ups ) resulting in veno-veno-arterial(VVA) or veno-arterio- venous(VAV) cannulation to provide circulatory and respiratory support at the same time.