The mechanical circulatory support (MCS) for pediatric patients with severe acute heart failure and poor pulmonary conditions is challenging. Herein, we report the first pediatric case of successfully treated by central Y–Y extra-corporeal membrane oxygenation (ECMO). A 10-year-old boy weighing 35 kg with a body surface area of 1.11 m² was transferred to our institution in cardiac arrest with ongoing cardiopulmonary resuscitation using intra-aortic balloon pump and peripheral ECMO inserted at the previous hospital. Then, MCS system was converted to central ECMO with left heart drainage due to severe pulmonary congestion and the anticipation of long-term MCS. After 3 days, we converted it to central Y–Y ECMO because of concern about intracavitary thrombus formation due to poor pulmonary conditions. After four more days, the pulmonary conditions were improved, and we converted the MCS system into left ventricular assist device (LVAD) system. He is awaiting the heart transplantation eligibility review in a stable condition. Central Y–Y ECMO system can be used as a bridge to decision also for a pediatric patient with acute severe heart failure and poor pulmonary conditions.