Khaled is a 58yo male with a history of hypertension and Type II DM who after a week of flu-like symptoms, was found unresponsive in the bathroom by family. He was in asystole when EMS arrived and CPR was started with ACLS protocol. He received numerous rounds of drugs and did have ROSC on two occasions with systolic pressures in the 80’s but returned to PEA. CPR was ongoing as he arrived in the ED where additional efforts established a sinus rhythm with RBBB. He was transferred to the ICU where he required infusions of Norepinephrine, Dopamine, Dobutamine, and Vasopressin to maintain a systolic pressure of above 80. His initial CXR showed multiple rib fractures and a right pneumothorax for which a chest tube was placed. You are called with a request for urgent VA ECMO for his viral ARDS and persistent post-arrest shock.