Sharon is a 77yo female with a history of HTN, DM II, and renal insufficiency who presented to the ED with SOB and was found to have a large pericardial effusion with an EF of 55-60%, but with moderate RA and mild RV diastolic collapse, consistent with tamponade physiology. She underwent an uneventful subxiphoid pericardial window, monitored with TEE. Several hours later in the ICU she abruptly arrested, was quickly resuscitated and found on EKG to be having an acute inferior MI. She was taken immediately to the cardiac catheterization lab where she was found to have a totally occluded RCA with a 60% proximal LAD lesion. An attempt at rescue angioplasty was complicated by an RCA dissection, and she had significant cardiovascular collapse. Pressors were initiated and an IABP was inserted, and she was urgently transferred by helicopter to the operating room at the nearby tertiary care facility for emergency 2 vessel CABG. She failed several attempts at weaning from CPB with the IABP and multiple pressors. A request was made to transition her to VA ECMO for bridge to recovery from her cardiac stunning.