Extracorporeal membrane oxygenation (ECMO) is indicated for a patient with acute severe respiratory failure whose life cannot be maintained by conventional ventilator management, or whose lungs can be injured irreversibly by continuing conventional ventilator management. Actually it is not easy to decide the indication because ECMO must consume enormous costs and needs a great deal of manpower. It was reported that the ECMO results for H1N1 influenza in 2009 of Japan were inferior to those of other developed countries. It has been suggested that the reasons for this was a lack of specialists, a lack of adequate equipment, and a lack of centralizing patients. The ECMO project in Japan was started in 2012 for improving ECMO results, and it has focused on registering patients, providing information about ECMO equipment, and organizing conferences for case presentations and simulation training.