Ventricular assist devices (VADs) are used in children with severe heart failure as a bridge to heart transplantation or recovery. Severe pulmonary dysfunction may preclude their use, leaving extracorporeal membrane oxygenation (ECMO) as the most frequently used option for combined cardiac and respiratory failure. There are few case reports describing the use of an oxygenator in combination with VAD support, but none that describes long-term utilization. We report the successful use of a low-resistance oxygenator placed into the right-sided VAD (RVAD) circuit of an infant with life-threatening respiratory failure. The oxygenator enabled immediate reversal of hypoxaemia and hypercarbia and recovery of the RVAD function. The oxygenator remained within the VAD circuit for 15 days, facilitating complete lung recovery. An oxygenator used in conjunction with a VAD may be a life-saving therapy, allowing adequate oxygenation and ventilation in severe respiratory and cardiac failure. Extended use may facilitate the prevention of ventilator-associated lung injury and organ dysfunction. This therapy may be an attractive intermediate step in the transition from, or alternative to ECMO, in patients requiring VAD placement with associated acute lung injury. © 2013 The Author. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.