To summarize the nursing experience of a patient with severe acute respiratory distress syndrome caused by Aspergillus fumigatus infection undergoing veno-venous extracorporeal membrane oxygenation in prone position treatment. In response to severe pulmonary infections，the transportation risks during prone ECMO，anticoagulant management，as well as the multiple drug resistant bacterial infections in the patient，we adopted personalized prone position and precise drainage strategy to optimize lung infection control，safe and precise pipeline management strategy to ensure the safe transport of ECMO in prone position，goal oriented anticoagulation management to balance the risks of bleeding and thrombosis，multiple pathway combined antibacterial strategy to enhance efficacy of treatment and reduce side effects. After 57 days of treatment and nursing，the patient’s condition was stabilized and discharged smoothly.