Edward is a 56yo male who has undergone multiple operations related to ulcerative colitis and recurrent episodes or small bowel obstruction, and resection of necrotic segments of small bowel. He was recently admitted again with abdominal pain and required surgery for abdominal sepsis from multiple abscesses. His abdomen was left open and covered with a VAC system. He developed ARDS which progressed resulting in transfer for a higher level of care to your institution. Despite elevated ventilator support, his saturations fell into the 50% range and he arrested, requiring about 3 minutes of CPR. His ventilator was changed to APRV on 100% with improvement in his saturations to 90%. Three days later he is unchanged and has not yet woken up. He is on CVVHD for AKI developed during his initial sepsis at the referring hospital. Because of his failure to improve and persistent high vent settings off and on for the past 27 days, you are asked to consider him for ECMO support.