David is a 64yo male with a history of HTN, insulin dependent type II DM, and peripheral vascular disease presented to the ED at your hospital with fever, chills, and a non-healing right toe ulcer. He is found to have a murmur on exam, and a subsequent echo demonstrated vegetations on his aortic valve, with moderate AI. He was started on broad spectrum antibiotics which were adjusted when his blood cultures returned positive for group B strep. Over the next 48 hours he had progressive worsening SOB requiring intubation, so he was taken to the operating room for emergency aortic valve replacement. He returned to the ICU with reasonable cardiac function on 2 inotropes. On the morning of POD #1 he experienced a sudden episode of pulseless VT and after about 3 minutes of compressions he was successfully cardioverted and his rate controlled at 90 with his surgical temporary pacing wires. He then developed a worsening metabolic acidosis and some hypoxemia and arrested a 2nd time, with immediate compressions and ACLS protocol which successfully restored his rhythm and blood pressure after 10 minutes. A rapid bedside echo showed an EF of 20% with global dysfunction and possibly some clot in the RV raising concern of a PE. At this point he was requiring Norepinephrine, Dopamine and Vasopressin to maintain his blood pressure, so you are called to evaluate him for VA ECMO support.