1. age ≥70 year old 2. extubation likely in next 24-48 hours 3. duration of mechanical ventilation ≥7days 4. ≥2 non-pulmonary organ failures (as scored by the sequential oxygen failure assessment (sofa) score) 5. need for immediate vv ecmo (as per eolia (research study) criteria\*) 6. requirement for va ecmo 7. clinical frailty or ≥2 major comorbidities 8. the physician deems the study is not in the patient's interest * eolia criteria (p:f \<50 for 3 hours, p:f\<80 for 6 hours, ph\<7.25 with carbon dioxide partial pressure (pco2) \>60 for \>6 hours

1. age ≥70 year old 2. extubation likely in next 24-48 hours 3. duration of mechanical ventilation ≥7days 4. ≥2 non-pulmonary organ failures (as scored by the sequential oxygen failure assessment (sofa) score) 5. need for immediate vv ecmo (as per eolia (research study) criteria\*) 6. requirement for va ecmo 7. clinical frailty or ≥2 major comorbidities 8. the physician deems the study is not in the patient's interest * eolia criteria (p:f \<50 for 3 hours, p:f\<80 for 6 hours, ph\<7.25 with carbon dioxide partial pressure (pco2) \>60 for \>6 hours

age ≥70 year old extubation likely in next 24-48 hours duration of mechanical ventilation ≥7days ≥2 non-pulmonary organ failures (as scored by the sequential oxygen failure assessment (sofa) score) need for immediate vv ecmo (as per eolia (research study) criteria*) requirement for va ecmo clinical frailty or ≥2 major comorbidities the physician deems the study is not in the patient's interest eolia criteria (p:f <50 for 3 hours, p:f<80 for 6 hours, ph<7.25 with carbon dioxide partial pressure (pco2) >60 for >6 hours

age ≥70 year old extubation likely in next 24-48 hours duration of mechanical ventilation ≥7days ≥2 non-pulmonary organ failures (as scored by the sequential oxygen failure assessment (sofa) score) need for immediate vv ecmo (as per eolia (research study) criteria*) requirement for va ecmo clinical frailty or ≥2 major comorbidities the physician deems the study is not in the patient's interest eolia criteria (p:f <50 for 3 hours, p:f<80 for 6 hours, ph<7.25 with carbon dioxide partial pressure (pco2) >60 for >6 hours

1. age ≥70 year old 2. extubation likely in next 24-48 hours 3. duration of mechanical ventilation ≥7days 4. ≥2 non-pulmonary organ failures (as scored by the sequential oxygen failure assessment (sofa) score) 5. need for immediate vv ecmo (as per eolia (research study) criteria*) 6. requirement for va ecmo 7. clinical frailty or ≥2 major comorbidities 8. the physician deems the study is not in the patient's interest - eolia criteria (p:f <50 for 3 hours, p:f<80 for 6 hours, ph<7.25 with carbon dioxide partial pressure (pco2) >60 for >6 hours

1. age ≥70 year old 2. extubation likely in next 24-48 hours 3. duration of mechanical ventilation ≥7days 4. ≥2 non-pulmonary organ failures (as scored by the sequential oxygen failure assessment (sofa) score) 5. need for immediate vv ecmo (as per eolia (research study) criteria*) 6. requirement for va ecmo 7. clinical frailty or ≥2 major comorbidities 8. the physician deems the study is not in the patient's interest - eolia criteria (p:f <50 for 3 hours, p:f<80 for 6 hours, ph<7.25 with carbon dioxide partial pressure (pco2) >60 for >6 hours