Coronavirus disease 2019 (COVID-19) pneumonia caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2) had a profound impact on global healthcare. As their respiratory status deteriorates into acute respiratory distress syndrome (ARDS), patients with severe COVID-19 pneumonia require longer ventilatory support in the intensive care unit (ICU), compared to those with non-COVID-19 ARDS. Although it has been previously reported that patients with non-COVID-19 ARDS are at high risk (29%–35 %) for ventilator-associated pneumonia (VAP), VAP complications are reportedly more frequent (36.1%–86 %) in severe COVID-19 pneumonia with ARDS due to long-term ventilator management [[1], [2], [3]]. In addition, VAP complications further prolong the duration of ventilator support with increased risk of mortality in patients with severe COVID-19 pneumonia [4]. However, there have been few reports of VAP in patients with severe COVID-19 pneumonia in Japan [5]. We do not know clearly about VAP in severe COVID-19 pneumonia in the Japanese population. Therefore this study evaluated the epidemiology of VAP in patients with severe COVID-19 pneumonia with ARDS at a Japanese extracorporeal membrane oxygenation (ECMO) center treating patients with the most severe COVID-19 pneumonia.