Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with fewer neurological complications and decreased mortality compared to veno-arterial (VA) ECMO in neonatal respiratory failure. The Crescent right atrial (RA) cannula is the only dual-lumen cannula for neonatal VV ECMO designed to have the tip in the right atrium. The purpose of this study is to describe the experience with early use of the Crescent RA cannula. We performed a retrospective cohort study of 58 neonates and infants cannulated from September 2021 through August 2023 at 15 institutions represented within the Children’s Hospital Neonatal Consortium (CHNC) ECMO Focus Group. Members provided information on patient characteristics, ECMO runs, complications, and outcomes. Data were analyzed with descriptive statistics. Imaging was used during cannulation in 79.3% of cases. Survival to discharge was 84.5%. There was one major cannula-related complication resulting in death. The most common complication was cannula malposition in 46.6% of patients, requiring surgical repositioning in 29.3% of the total cohort. Early use experience with the Crescent RA cannula suggests that it is effective and safe in most patients, but the cannula may require repositioning to achieve optimal ECMO support or if malpositioned. Based on these observations, we developed recommendations for cannulation and cannula surveillance.