CASE PRESENTATION: Case 1: 29-year-old female with multiple asthma exacerbations admitted with respiratory failure, pH of 6.76 and pCO2 of 152 despite mechanical ventilation. She was emergently placed on VV-ECMO in the ED. During initiation of VV-ECMO patient had cardiac arrest and was resuscitated. Normalization of blood gases was achieved within 2 hours and patient was liberated off VV-ECMO in 4 days. Case 2: 24-year-old man with a history of asthma with no previous intubations suffered a PEA arrest and was resuscitated in the field. On presentation to emergency department had respiratory acidosis with a pH of 6.8, he suffered a second PEA arrest, emergently was started on VV-ECMO, follow-up blood gases showed rapid resolution of acidosis and patient was able to be decannulated within 36 hours of initiation of treatment. Case 3: 28-year-old man with untreated asthma initially presented with worsening SOB symptoms over several weeks. Patient started traditional treatment for asthma exacerbation, but progressed to respiratory failure and was intubated. Initial ABG pH of 7.24 with pCO2 of 44. Despite mechanical ventilation pH decreased to 7.10 with pCO2 of 78. VV-ECMO was initiated and patient had rapid improvement of acidosis and was weaned off VV-ECMO within 48 hours. Case 4: 15-year-old male brought by EMS with ongoing CPR for cardiac arrest, VV-ECMO was immediately started, initial pH of 6.82 and pCO2 of 96. Despite quick return of circulation and complete normalization of blood gases within one hour, our patient sustained anoxic brain death due prolonged CPR prior to arrival to ED.