Stephanie is a 35yo female with a history of Lupus (SLE) first diagnosed 8 years ago. She has been treated as an outpatient and maintained on prednisone for the last 3 years. She was on Cytoxan for a few months earlier this year. She is also on metoprolol for HTN and Amlodipine for Raynaud’s symptoms. Two days ago she presented to her local physician with a 3-week history of weight gain, swelling in her feet and ankles, and is now having chest pain and SOB. Her saturation in the office was 90% and she was transferred by ambulance to your institution where her rheumatologist practices. Over the next 24 hours her hypoxia rapidly progresses requiring intubation and increasing ventilator support, and subsequently sedation and paralysis. She remains stable hemodynamically. You are consulted for VV ECMO for her acute respiratory failure secondary to lupus pneumonitis with Diffuse Alveolar Hemorrhage, and associated with pericarditis and nephritis.