Tracheal invasion of thyroid cancer is a less common complication that occasionally requires severe perioperative airway management. Recently, extra corporeal membrane oxygenation (ECMO) has been used for inducing general anesthesia in cases of tumor resection with severe tracheal invasion. Here we report two cases of thyroid cancer highly invading the trachea, where VA-ECMO was successfully used for surgical resection. The first case was a 68-year-old female, who presented with a persistent cough and progressive airway obstruction. CT revealed a thyroid tumor with severe tracheal invasion as well as multiple lung metastases, and cytology showed the possibility of papillary thyroid carcinoma or thyroid anaplastic cancer. Since approaches to tracheostomy or intubation were extremely difficult due to the invasive tumor, we used VA-ECMO, followed by tracheotomy and induction of general anesthesia. As intraoperative frozen sections revealed the presence of anaplastic thyroid cancer in an unresectable state, tracheoesophageal separation was performed in consideration of post-operative airway management. The second case was a 73-year-old female, who was referred to our hospital with suspicion of thyroid cancer. She had suffered from a persistent cough for several months, and a trachea-invading thyroid tumor was radiographically identified. As in the first case, we used VA-ECMO, followed by tracheostomy and induction of general anesthesia. Total thyroidectomy and bilateral neck dissection were performed. This report reviews airway management based on ECMO, particularly focusing on differences of VA-ECMO and VV-ECMO, and cannulation approaches. ECMO can be a safe and useful method for surgery of head and neck tumor with severe airway obstructions, where appropriate selection of the types of ECMO and cannulation approaches is important.