Venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy can be indicated as a last resort treatment in severe respiratory failure. It is a complex and resource demanding treatment that can pose challenges, particularly during a pandemic such as COVID-19. We report two cases of previously healthy, middle-aged men who suffered severe respiratory failure following COVID-19 pneumonia. Both patients required VV-ECMO therapy at a low-volume, geographically isolated center in Iceland, a country of 400,000 inhabitants. They recovered well after the VV-ECMO treatment and returned to full-time work approximately one year later.