After satisfactory development and testing of a polyurethane 14 Fr double lumen catheter, we used this device for venovenous extracorporeal life support in neonates who had respiratory failure. This catheter was designed for single site cannulation of the internal jugular vein, thereby sparing the carotid artery from ligation. Cannulation was successful in 17 of 21 neonates, with 15 successful venovenous runs, whereas 2 of the 17 patients were converted to venoarterial bypass because of inadequate support. Oxygenation and CO2 removal were adequate in the remaining patients. Average time on bypass was 111 hours. All 15 patients survived, and exploration of the cannulation site for bleeding was required in three patients. Preoxygenator pressure, recirculation of oxygenated blood, and hemolysis were all within acceptable levels during each run. Venovenous extracorporeal life support with the double lumen catheter can replace venoarterial access in most cases of neonatal respiratory failure.