A 34-year-old woman developed influenza A (H1N1) infection with a markedly elevated serum galactomannan index of 5.436 after a week of fever and rapidly progressive dyspnea. Despite invasive mechanical ventilation, there was refractory acute respiratory failure with extreme airway resistance of 190 cmH2O/l/s and extensive subcutaneous emphysema. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated as a bridge to bronchoscopy, which revealed extensive necrotic pseudomembrane in the airways. Bronchoalveolar lavage and metagenomic sequencing confirmed coinfection of Aspergillus fumigatus with influenza A (H1N1), establishing a diagnosis of influenza-associated pulmonary aspergillosis (IAPA). Treatment included systemic and bronchoscopic antifungal therapy with amphotericin B along with repeated airway clearance. Despite complications such as secondary Pseudomonas aeruginosa infection and suspected drug-induced hemolysis, the patient was successfully weaned from ECMO on March 22, 2023 and discharged after improvement. VV-ECMO with repeated bronchoscopic interventions served as a rescue strategy in invasive IAPA with refractory respiratory failure.