This multicenter case series examines the safety and feasibility of using alternative venous access sites for dual-lumen cannulas in veno-venous (VV) extracorporeal membrane oxygenation (ECMO) when the right internal jugular vein (RIJV) is inaccessible. Data from three high-volume ECMO centers were analyzed, involving 20 patients who required alternative access due to inaccessible RIJV. The study found no procedural complications with alternative sites, which included the left internal jugular, subclavian, and femoral veins. The outcomes were promising with half of the patients successfully bridged to lung transplantation or recovery, highlighting the viability of these alternative sites for critical ECMO support.