Objective To analyze retrospectively the effects of extracorporeal membrane oxygenation (ECMO) on the therapy of severe acute respiratory distress syndrome (ARDS). Methods A patient with severe ARDS caused by smoking bomb was treated with veno-arterial ECMO for 41 days. The hemodynamics,lung imaging,mechanical ventilation parameters,percutaneous arterial oxygen saturation, acid-base balance, blood lactate, and heart, liver, kidney, brain function changes of the patients were observed continuously. Results The patient with severe ARDS treated with ECMO maintained physiological levels of arterial blood gas, tissue oxygen supply and acid-base balance for a long time,and kept good functions of heart,lung,kidney,brain. On the 41th day,the patient terminated treatment because of severe pulmonary infection and probable brain hemorrhage. Conclusions ECMO can provide effective support for lung function, give an opportunity for pulmonary rehabilitation of ARDS patients and further clinical treatment. Hemorrhage and thrombosis are the key problems of ECMO.