Marvin is a 56yo 104kg male former smoker with a history of Hypertension and COPD, who presents to his local hospital with a 1-2 week exacerbation of his shortness of breath, non-productive cough, and wheezing, which has been unresponsive to his inhalers and oral steroids. In the ED he is found to be in moderate distress with a WBC count of 20K. After failing to improve on a trial of BiPap, he was intubated and moved to the ICU. Over the next 48 hours he requires increasing levels of ventilator support for worsening hypoxemia. He has a fever of 102.8, and his blood cultures return positive for MRSA. He is maintained on infusions of Fentanyl, Versed and Rocuronium. He develops worsening hypotension despite fluid resuscitation and overnight requires increasing levels of norepinephrine and subsequently vasopressin and by morning has become anuric. He did not tolerate prone positioning due to blood pressure. The outside hospital is calling to request transfer to your center for possible ECMO, and provides the following additional information for your consideration.