CASE REPORT
A 53-year-old female was transferred for acute respiratory failure and intubated upon arrival. A significant bronchopleural fistulas (BPF) compromised mechanical ventilatory support so she was placed on VV-ECMO (right internal jugular vein 17-Fr inflow cannula with a 23-Fr drainage multistage right femoral venous cannula). For 6 weeks, she improved but her extensive BPF required continued extracorporeal support. The multidisciplinary ECMO team agreed on conversion to a single dual lumen cannula as this will allow better mobility and improve her comfort. We decided to access the left subclavian vein as this will allow us to transition cannulation strategies without interrupting her ECMO circuit or changes in the ventilatory support.