The use of extracorporeal membrane oxygenation (ECMO) in the paediatric population has increased over time, with the ability to rescue pulmonary and cardiovascular deterioration. ECMO can be utilised by neonates and children with congenital heart disease in both preoperative and postoperative settings to improve survival and minimise morbidity. ECMO cannulation strategy must be tailored to the age, weight, and physiologic state of the patient. Careful patient selection and rapid deployment of ECMO may improve survival and morbidity in patients with congenital heart disease.