An 11-month-old infant was admitted to the intensive care unit after cardiorespiratory arrest associated with the parainfluenza virus. Despite interventions, deterioration persisted. Echocardiography revealed severe pulmonary hypertension, tricuspid gradient >100 mm Hg, and right ventricular dilation. Maximal vasodilator therapy failed. At 72 hours, cardiogenic shock led to carotid-jugular venoarterial extracorporeal membrane oxygenation (ECMO). Unsuccessful weaning by day 22 prompted the consideration of a lung transplant. During this time, ECMO arterial cannula clotting occurred, requiring sternotomy for atrial-aortic ECMO.