Venoarterial extracorporeal membrane oxygenation (VA ECMO) may be used in patients with advanced cardiac or pulmonary failure. Arterial cannulation via the femoral arteries is suboptimal in many clinical scenarios because of associated complications and the potential for differential hypoxemia between the upper and lower body. To address these concerns, we typically use an upper body configuration (sport model) with right internal jugular and axillary or subclavian artery cannulation to allow a safe and durable means of providing VA ECMO support without differential hypoxemia. Unfortunately, this approach may not be feasible in smaller patients, whose vessels may preclude optimal use of the axillary or subclavian arteries and in those with systemic vasculopathy associated with connective tissue disorders. We describe a new approach for patients of small stature using the innominate artery through a mini-upper sternotomy in seven patients.