Judith is a 36yo 198kg female with a history of congestive heart failure and type II DM and presented to her local hospital with SOB and leg swelling. She was admitted to the hospital where her SOB worsened requiring BiPAP and then intubation. She improved over time with diuresis and antibiotics and was successfully extubated. Soon after that she developed skin eruptions and erythema, and is diagnosed with Group-A strep cellulitis, presumed sepsis, and possible Steven-Johnson’s syndrome versus toxic epidermal necrolysis (TEN). She was transferred to the Burn Unit at your institution where she was diagnosed with probable TEN with 40% TBSA involvement. She was also noted to have oral mucosal involvement with sloughing. Elective Intubation was recommended at that time by the burn unit team but the patient refused unless it was an absolute emergency. She was managed on CPAP, first at night, and then 24 hours as her SOB worsened. She had several short episodes of atrial fibrillation with ventricular rates in the 200 range and was started on beta-blockers. The next morning she was found unresponsive with her CPAP off, was intubated and resuscitated including a brief period of chest compressions, and then placed on High Frequency Percussive Ventilation (HFPV) and norepinephrine. You are called to consider her for ECMO support.