The patient, a 64-year-old woman, had a history of bronchiectasis. She experienced a sudden onset of major hemoptysis and was transported by ambulance to our facility. Tracheal intubation and bronchoscopy were performed. Because the hemoptysis had resolved by the time she arrived at our hospital, a conservative approach with close observation was adopted. On hospital day 3, the patient experienced massive hemoptysis accompanied by poor oxygenation, and veno venous extracorporeal membrane oxygenation (VV-ECMO) was initiated. Angiography results indicated bleeding from the right bronchial artery. Vascular embolization with gelatin sponge particles (Serescue^®, Astellas) was performed to stop the bleeding. Oxygenation did not improve, and tracheobronchial oozing was observed. Therefore, severe limitations were placed on anticoagulant therapy during ECMO. The tracheobronchial area was filled with blood clots, and respiratory management was conducted while carefully removing blood clots via bronchoscopy. High frequency oscillatory ventilation was started on hospital day 15, when ventilation of the lungs gradually began to occur. On hospital day 32, the patient was taken off ECMO. On hospital day 95, the patient was transferred to a different hospital to undergo rehabilitation. This patient had a high risk of hemorrhage, and strong limitations were placed on the use of anticoagulants during ECMO. However, thrombotic complications occurred only once during the ventilator circuit change, and ECMO was safely discontinued despite restrictions on the use of anticoagulants.