COVID-19 patients can experience severe or critical symptoms, which develop into an acute respiratory distress syndrome (ARDS) necessitating an intensive care, of which 80% demanding the mechanical ventilation therapy. Patients with severe and critical infection from COVID-19 can receive Extracorporeal membrane oxygenation (ECMO) therapy. This study reported a successful ECMO therapy at Soetomo Hospital in Surabaya, Indonesia, despite all the problems which occurred during ECMO support especially with coagulation conditions. Thus, an anticoagulant therapy contributed significantly in the success of ECMO therapy.