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I've looked around, and can't find a solution.

I tried replacing the intro vids with blank placeholders, and at least it gets to the 'Loading' screen.

The Icon next to the "Loading" message flashes for a while, then i get a CTD (Crash to desktop).

Running Win 10, 1903.
Intel i7-8700k 3.7Ghz
Nvidia 1080ti FTW3, latest driver
32GB Ram
ASUS PG279Q Monitor

Uninstalled Geforce Experience, as I saw that as a suggestion.
Game is set to run as administrator, and it doesn't matter if I launch with or without the GOG Galaxy 2.0 client.

I see this in event viewer:

Faulting application name: GreedFall.exe, version:, time stamp: 0x5d9721bf
Faulting module name: Engine.dll, version:, time stamp: 0x5db306cd
Exception code: 0xc0000005
Fault offset: 0x000000000045b38a
Faulting process id: 0x2f4c
Faulting application start time: 0x01d5b80b14a8a6b2
Faulting application path: M:\GOG Games\GreedFall\GreedFall.exe
Faulting module path: M:\GOG Games\GreedFall\Engine.dll
Report Id: 8e57b601-7c0c-42a8-a4cb-db6a57d10bbd
Faulting package full name:
Faulting package-relative application ID

Any thoughts?
Unfortunately, this fault can be caused by almost anything, last time I had this little gem the issue was a faulty memory module. I'd recommend the usual: do a /scannow, ensure things like DirectX are up to date, use Geforce Experience to "optimise" the game, re-install a clean copy.

Aside from the problem at hand I must offer my thanks. I wanted this game as I followed it through development, until I discovered it wouldn't be launched on GOG at the same time as it would on other platforms. Like Road to Eden this really put me off purchasing now it's released on GOG, but I was still on the fence. I decided to read some of the forums before finally getting off that fence and making the purchase today but problems like yours (and lack of developer response) have made me decide not to buy it.
I'm pulling this off the top of my head but it sometimes helps for GOG games.

Make sure to run the game directly from its executable file (GreedFall.exe) and not through GOG Galaxy.
tnoyce: ...
Contact GOG or Spiders or Focus Home support?
Anybody got real help from technical support with the "game won't start/open" problem?
I have GreedFall on my two computers with different OS versions (Windows 8 and 10), really powerful machines and the game doesn't want to open on either of them. And unfortunately the support is in fact "support".
Go to this forum post... In case it's deleted just disable media foundation via the codec tweak tool!

Hope this works for you!