We present a new and successful method of carotid artery cannulation without ligation of the carotid artery for extracorporeal membrane oxygenation (ECMO) in two neonates with severe respiratory failure caused by meconium aspiration and sepsis. ECMO was carried out for 4 and 17 days, respectively. Both neonates showed normal neurologic findings and normal transcranial Doppler scans during and after ECMO.ECMO has been used successfully to treat severe respiratory failure in neonates (1). Survival rates are 90% in neonates with an expected mortality rate of 80%, using conventional respiratory support (2). However, ECMO usually requires ligation of the carotid artery, because of the risk of cerebral embolization. This adverse consequence of ECMO (i.e., carotid artery ligation) might be one of the causes for the high occurrence of right hemispheric brain lesions in ECMO-treated children (3). Recently, Crombleholme et al. (4) described a technique for the reconstruction of the carotid artery after ECMO and speculated that carotid artery reconstruction may decrease the occurrence, or limit the extent of right-side brain injury and obviate the long-term consequences of compromised right hemispheric perfusion. We used a different technique of carotid artery cannulation and reconstruction in two neonates with severe respiratory failure.