George is a 72yo male with a history of hypertension, hyperlipidemia, and Type II DM, who is 4 days post 3 vessel CABG at a nearby medical center. He has been experiencing severe nausea from his pain medication and vomited and aspirated. Within 12 hours he develops severe ARDS and is intubated and on escalating ventilator settings for his hypoxemia. He shows no improvement despite sedation and paralysis, and maximal ventilator support. He did not improve with prone positioning. He is beginning to have some hypotension and they are considering starting an epinephrine infusion. You are called to consider him for ECMO support.