This article was first published in the Fall 2020 issue of Critical Connections.   An infant with complex cyanotic congenital heart disease (CHD) underwent initial palliative surgical repair complicated by prolonged extracorporeal membrane oxygenation (ECMO) and stroke. She was successfully weaned off ECMO but required intensive care unit (ICU) hospitalization for several months due to prolonged respiratory failure from deconditioning. She was eventually discharged home on oxygen but had frequent desaturation episodes leading to readmissions. She spent less than 3 cumulative weeks at home before readmission at age 8 months for her third open heart surgery. Physicians expected that her desaturation spells would improve significantly after surgery.   Critical Connections is the critical care industry’s only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team. Authors: Catherine S. Heith, MD Sabrina F. Derrington, MD, MA, HEC-CCatherine S. Heith, MD, & Sabrina F. Derrington, MD, MA, HEC-C