To minimize the chance of ventilator induced lung injury (VILI), in patients who develop adult respiratory distress syndrome ARDS), Extracorporeal Oxygenation Membrane (ECMO) is a common clinical intervention. The goal of venous-venous ECMO is to provide stable gas exchange, while the goal of the ventilator is to preserve the patient's pulmonary mechanics and minimize VILI. When ECMO parameters are maximized and gas exchange is marginal, often then the ventilator is called upon to help improve or maintain gas exchange often requiring high pressures and oxygen delivery (FI02). An alternative strategy to meet this objective is to utilized high frequency percussive ventilation (HFPV) via the VDR-4 (Sandpoint, Idaho). HFPV provides both an endobronchial wedge via the percussive rate and an oscillatory plateau via the connective rate. With this strategy lower pressures and oxygen delivery can be employed and ECMO parameters can be often reduced. From Jan 2015 to Feb 2016 we utilized the VDR on fifteen V-V ECMO patients. Thirteen (86.7%) of fifteen patients both ECMO FIO2 and sweep were reduced with in twenty-four hours. (Table 1) HFPV pressures and FIO2 were maintain lower than 60% and airway pressure ≤ 40cmH20. (Table 1) Prior to placing on HFPV a pressure/tool measurement was performed to determine starting airway pressure and PEEP parameters to set on the VDR. Based on the above results, HFPV can help ECMO maintain gas exchange for patients at a lower FIO2 and sweep settings.