Objective To explore the feasibility and safety of bronchoscopy treatment in severe airway obstruction with extracorporeal membrane oxygenation (ECMO) support. Methods Clinical data, surgical procedure, complications and efficacy of respiratory endoscopic surgery for two patients with central airway obstruction were retrospectively analyzed. Results For case 1, left main bronchus spherical mass was completely removed with the lumen patency rate of 100% and the right main bronchus lumen open about 50%. For case 2, airway obstruction was relieved about 90 percent. Blood loss was about 70 ml for case 1 and 300 ml for the case 2 during the procedure. Dyspnea was relieved after surgery and no hospital death was observed. Conclusion ECMO technology can improve the safety of respiratory endoscopy surgery and provide new assistance for the minimal invasive endoscopic surgery in severe airway obstruction.