Transfer of injured service members from the Level 3 combat support hospital to level 4 and 5 medical facilities increase their chance of survival from devastating injuries. Aeromedical evacuation of patients with Acute Respiratory Distress Syndrome ARDS is sometimes beyond the possibilities because of limitations providing ventilator support in flight with a possible further deterioration in patient status. Cell based therapy with adult bone marrow-derived mesenchymal stromal cells MSC in experimental models of ARDS data suggest that administered allogeneic B-MSCs can mitigate hypoxemia and promote recovery. However, it is unknown how this new form of therapy can be used adjunct to current supportive measures for lung failure. Our objective is to complete a series of preclinical studies in large animal models using extracorporeal membrane oxygenation ECMO alone or in combination with MSC in sheep and pigs with ARDS. Our group had completed the first 19 experiments in which we demonstrated that 3.5 ugkg of LPS infused i.v. to a sheep induces lung injury equivalent to a moderated ARDS. In a second group of studies sheep in which respiratory support was providing by a low flow-low pressure ECMO ALung partially rescued the animals returned the parameters of respiratory function to normal values. It is our goal to now use Alung in combination of MSCs to potentiate their protective effect.