Devon is a 45yo previously healthy male who presented with a 2-week history of productive cough and SOB. He was treated with oral antibiotics as an outpatient without improvement. After 5 days he returned to the hospital and was admitted, and then rapidly deteriorated requiring intubation. He was managed on pressure control with 26/12 with Peep of 16, and 100% FiO2, but with pO2’s remaining in the low 50’s, and saturations in the mid 80’s. He was paralyzed and sedated and because of worsening hypoxemia he is transferred to your institution for possible ECMO. He arrived on epinephrine and norepinephrine and your pulmonary ICU team attempts a couple of different ventilator strategies and prone positioning without success, and call you for consideration for VV ECMO support.