INTRODUCTIONVeno-venous extra-corporeal membrane oxygenation (V-V ECMO) is used in perioperative respiratory care of patients with lung abscess, considered unfit for one-lung ventilation or who are functionally inoperable, despite exploiting all conventional mechanical ventilation possibilities, including nitric oxide inhalation. V-V ECMO does not pose higher odds of postoperative mortality.1Independent lung ventilation (ILV) is a mechanical ventilation treatment for differential lung disease, used in intensive care settings. ILV is divided into anatomical and physiological lung separation. Physiological lung separation is divided into synchronous and asynchronous ventilation.2Combined use of V-V ECMO and asynchronous independent lung ventilation can have a perioperative advantage of lung abscess because in lung abscess, the right and left lungs often have different characteristics.Herein, we describe the case of a patient who received V-V ECMO for thoracic surgery for lung abscess, in whom ILV was performed to provide asynchronous treatment during the perioperative period.