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ECMO Exam Questions with Correct Answers 100% Verified

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ECMO Exam Questions with Correct Answers 100% Verified

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ECMO Exam Questions with Correct Answers 100% Verified By
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Dr. John Gibbon Helped develop the first heart lung machine & had the first successful open
heart operation using the heart-lung machine in 1954.



Dr. Robert Bartlett The "father of ECMO" who pioneered ECMO technology, usage &
research. Surgeon who had the first neonatal ECMO survivor in 1972.



Robert Hooke English physicist who discovered the law of elasticity , known as Hooke's law ,
and constructed the Boylean air pump making him the first person to *conceptualize an
oxygenator*



Bubble Oxygenator An early implementation of the oxygenator which was first developed in
1882 by von Schröder of Strasburg when he used it to oxygenate an isolated kidney. It was later
used for cardiopulmonary bypass in 1950 by Clark, Gollan, and Gupta. It faced initial skepticism
but in 1956 it was demonstrated to be relatively simple, inexpensive, & easy to operate. The
device faced competition from membrane oxygenators, which arrived within the same decade
& were found to provide better oxygenation for periods over eight hours, and other advantages
beyond six hours. However, most open-heart operations were substantially shorter, and by
1976 it was predominant. In the 1980s, it was replaced by microporous membrane
oxygenators.



1916 Year Heparin was discovered when Jay Maclean demonstrates that a phosphatide
extracted from canine heart muscle prevents coagulation of the blood.



1929 Year of whole-body extracorporeal perfusion of a dog completed by the Russians
Brukhonenko and Tchetchuline.



1953 Year of first successful intracardiac repair using extracorporeal oxygenation & John
Gibbons heart-lung machine



10% By 1957, mortality from intracardiac surgery dropped from 50% to

,1971 Year of first successful adult ECMO patient who suffered polytrauma with aortic
transection & ARDS



Esmeralda Abandoned neonate who was successfully placed on ECMO in 1975. She suffered
meconium aspiration & spent 72 hours on ECMO (Prior to ECMO, meconium aspiration had a
90% mortality rate. Post ECMO, survival rate is 75%).



ELSO International organization created in *1989* which maintains a registry of both
facilities & specialists trained to provide ECMO services. It also maintains registry information
that is used to support clinical research, support regulatory agencies, & provides educational
programs for active centers as well as for facilities who may be involved in the transfer of
patients to higher levels of care



H1N1 First ever WHO "public health emergency of international concern" which CDC
estimated 284,000 deaths globally (mostly in Africa & Southwest Asia). In 2009, CESAR trail
increased ECMO use in adults & the development of national ECMO programs.


*CESAR* (Conventional ventilatory support vs extracorporeal membrane oxygenation for
severe adult respiratory failure) *Trail* Study during H1N1 flu epidemic that demonstrated
that patients with ARDS had better outcomes on ECMO then those with traditional ventilator
management. It helped increase ECMO use in adults & developed national ECMO programs. It
studied a total of 180 patients with primary endpoint measuring their survival without severe
disability at 6 months- 63% EMCO patients survived 6 months verses 47% without. Most
patients in the study developed severe ARDS with a P:F<75 & 30% of the control group did not
receive lung protective ventilation.



Centrifugal Pump Emerging ECMO technology that uses nonpostive displacement to allow
flow which is directly related to the patients condition. It is affected by both preload &
afterload.



PolyMethylPentene (PMP) Oxygenators Emerging ECMO technology which use true non-
porous membrane technology which can last a long period of time.

,Biocompatible Cannulas & Circuits Emerging ECMO technology which prevents clot
formation & platelet activation in the cannulas & circuit


1. Centrifugal Pump


2. PolyMethylPentene (PMP) Oxygenators



3. Biocompatible Cannulas & Circuits 3 Emerging ECMO Technologies




Diffusion The process that allows gas exchange between the alveoli & pulmonary capillaries.
It allows O2 & CO2 move from areas of high concentration to low concentration


pO2= 100



pCO2= 40 Partial Pressure of Oxygen (pO2) & Carbon Dioxide (pCO2) in the alveoli


pO2=40



pCO2=45 Partial Pressure of Oxygen (pO2) & Carbon Dioxide (pCO2) entering the alveolar
capillaries from venous circulation (in pulmonary artery)


1. Hemoglobin (98.5%)- oxyhemoglobin



2. Dissolved in Plasma (1.5%)- paO2 2 Ways Oxygen is Carried in the Blood

, 98.5% % of oxygen bound to hemoglobin



1.5% % of oxygen dissolved in plasma


1. Bicarbonate- HCO3 (60%)


2. Carbanimohemoglobin (30%)



3. Dissolved in Plasma (10%) 3 Ways Carbon Dioxide is Carried in the blood



Bicarbonate (HCO3) Formed when CO2 (released by cells making ATP) combines with H2O
(due to the enzyme Carbonic anhydrase)



60% % of carbon dioxide transported as *Bicarbonate*



Carbaminohemoglobin (HbCO2) Carbon dioxide bound to hemoglobin- hemoglobin
molecules loose their oxygen when they bind carbon dioxide



30% % of carbon dioxide transported as Carbaminohemoglobin



10% % of carbon dioxide dissolved in plasma


Aerobic



Anaerobic 2 Types of Cellular Metabolism



Aerobic Type of metabolism that creates energy with *oxygen*

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