A 23-year-old man with polytrauma sustained bilateral femoral fractures, a Gustilo IIIB open tibiofibular injury, and left radius-ulna fractures. He had severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia (PaO2/FiO2 40.5 mm Hg). One hour after the injury, he was started on veno-venous extracorporeal membrane oxygenation (VV-ECMO), which lasted a total of 144 hours. Surgical stabilization of fractures was performed on day 5 after physiological optimization with heparin anticoagulation and dynamic modulation of ECMO parameters. Lactic acidosis resolved from a peak of 5.0 mmol/L on day 1 to 1.8 mmol/L before surgery. The patient was successfully weaned from ECMO on day 6 and at 2-month follow-up achieved an SMFA score of 28.1 and a walking speed of 1.2 m/s. The case demonstrates the feasibility of a multidisciplinary protocol to manage oxygenation and hemorrhage control in patients with severe ARDS.