A 42-year-old man, without any previous underlying disease, was transferred to our hospital due to acute myocarditis caused by Coxsackie virus infection. Despite 2 days of supportive care and intravenous inotropic administration, his left ventricular ejection fraction (LVEF; 57%→30%%→10%) and hemodynamic status worsened progressively. Cardiac arrest occurred while preparing for extracorporeal membrane oxygenation (ECMO). Left atrial veno-arterial (VA) ECMO (LA-VA-ECMO) was performed via the right femoral artery and vein for LV unloading. After trans-septal puncturing, a 23-Fr Bio-Medicus NextGen multistage cannula (Medtronic, Minneapolis, MN, USA) was inserted with its tip placed in the left atrium (LA); one set of ports was placed inside the LA for LV venting and the other in the inferior vena cava (IVC) for simultaneous left-sided venting and venous drainage (Fig. 1A). After ECMO insertion, the electrocardiogram showed asystole. However, the patient was alert, and awake ECMO was maintained. Intensive conservative management was conducted, including continuous renal replacement therapy. On the third day, his conduction system recovered. Six days after cannulation, the hemodynamic status improved, and ECMO support was discontinued. Thereafter, LVEF recovered to normal, and he was discharged with outpatient follow-up.