Edward was turned down for support because of his cumulative condition and risks. If another relatively young patient developed ARDS from an acute infection, and had a brief arrest with 3 minutes of CPR, and a negative CT of the brain, one might argue to provide support, despite his lack of movement and consciousness after 3 days off paralytics and sedation. and his long time on the ventilator. Many of us have seen patients who take considerable time to clear sedation once placed on ECMO, especially if it was given as infusions during paralysis when it is difficult to determine the appropriate dosing. And some centers might be more liberal with the amount of pre-ECMO ventilator days that they will accept, as we learn more from long ECMO run survivors about the ability of the lung to repair itself.

However, for Edward the situation was much more dire. In addition to the long ventilator time, and the questionable neurological status, and his multiple organ failure with his renal failure, it was believed that his ARDS would not likely resolve given the continued severe inflammatory response in his abdomen that has been difficult to control. Support was withdrawn and he expired shortly after.