At surgery all staff in the room wore N95 masks and full PPE, including face shields, hats, and gowns. Under local anesthetic, the patient underwent bilateral femoral line placement to allow for more rapid conversion to ECMO if necessary. The nose and throat were topically anesthetized with sparing use of topical lidocaine cream, avoiding aerosolized topical anesthetic. She was successfully intubated awake using a fiberoptic bronchoscope and size 6 reinforced tube, which just reached the distal obstruction. The plan had been to initiate ECMO if fiberoptic intubation failed, in order to reduce risk of aerosolization of viral particles during an awake cricothyroidotomy.