Introduction: Central airway obstruction (CAO) is a life-threatening scenario which requires urgent intervention and often input from many specialties including intensive care, emergency medicine and ear, nose and throat surgery. The most common causes of CAO include malignancy and foreign bodies. It is very rare for benign multi-nodular goitre to cause life threatening central airway obstruction. Extracorporeal membrane oxygenation (ECMO) allows extended cardiopulmonary bypass, usually in the setting of hypoxaemic respiratory failure and cardiac support. Case: We discuss a rare case of a large, benign multi-nodular goitre in a 75 year old man resulting in an acute presentation to the emergency department with acute respiratory distress due to CAO and severe anatomical distortion, necessitating acute initiation of VV-ECMO as a life-saving measure to allow urgent thyroidectomy and tracheostomy. Results: Six months later, the patient has been successfully de-cannulated and discharged from ongoing outpatient follow-up, having returned to baseline function. Conclusion: The use of ECMO in the acute setting for management of a difficult airway is still novel, and consensus recommendations for patient selection and intervention do not yet exist. This case supports the use of VV-ECMO as a bridge to definitive intervention in the setting of acute CAO where intubation and front of neck access are unable to be safely and effectively established in the emergent setting.