Although venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for trauma patients with severe respiratory failure, its mortality rate is 27%, and optimal metabolic markers for its initiation remain uncertain. We investigate the prognostic value of pre-cannulation lactate in trauma patients receiving early VV ECMO. This retrospective cohort study (2015–2024) included trauma patients undergoing VV ECMO. Early VV ECMO was defined as cannulation within 72 h post-injury. The primary outcome was prognostic validity of pre-cannulation lactate levels, analyzed using Injury Severity Score (ISS)-adjusted logistic regression analysis and receiver operating characteristic (ROC) curves. Among 37 patients who received VV ECMO, 30 (81%) received early VV ECMO. Survivors had lower median pre-cannulation lactate levels than non-survivors (5.50 vs. 10.50 mmol/L, p = 0.002). Receiver operating characteristic curves revealed a cutoff of 8.80 mmol/L (area under the curve = 0.852, sensitivity = 0.750, specificity = 0.875). Using ISS-adjusted multivariate logistic regression analysis, lower pre-cannulation lactate levels predicted survival (odds ratio, 1.383; 95% confidence interval, 1.077–1.776; p = 0.011). Lower pre-cannulation lactate levels correlated with improved survival in trauma patients resuscitated using VV ECMO. Therefore, early VV ECMO might be considered in trauma patients before significant increases in lactate levels.