We report herein our experience with extracorporeal membrane oxygenation (ECMO) for respiratory failure over a 3-year period. ECMO was employed in seven patients: in five for respiratory failure caused by adult respiratory distress syndrome (ARDS), Goodpasture's syndrome, hypoxia after ventricular septal defect closure, interstitial pneumonia, or lung metastasis from choriocarcinoma; and in two for tracheal obstruction. Nafamostat mesilate was used as the main anticoagulant with a small amount of heparin. The period of ECMO support for the five patients with respiratory failure ranged from 54 to 251 h, with an average time of 125 h. Five of the seven patients were able to be weaned from ECMO, and the two who had tracheal obstruction survived. The other three patients who were weaned from ECMO died of underlying diseases or complications 1-25 days after weaning. The complications which occurred during ECMO support were an abnormal electroencephalogram, multiple organ failure, and mediastinitis. Thus, we conclude that ECMO needs to be induced early to obtain a better outcome in patients with respiratory failure, and that it is particularly effective for transient airway obstruction.