ECMO Specialist Exam 2025

How to recognize cardiogenic shock? (acronym) - Correct Ans-CS-MODE Cardiac Rhythm SBP 90 Markers- cardiac Output- oliguria Drips - Inotropes/ pressers Exam - cool, clammy, resp distress How to diagnose shock ( acronym) - Correct Ans-(ECLS ) ECG Consult- surgeon Labs- lactates, abgs etc. Swan catheter what is PAPI score? Formula and normal value - Correct Ans-differentiates between the LV/RV disfunction, if low = RV dysfunction PAPi= (sPAP-dPAP)/RA it is the pa sys - the pa dyastolic / right atrial pressure- can get these numbers from swan normal is 1.0 Formula for cardiac power output (CPO) and normal value - Correct Ans-CPO= MAP x CO/451 normal = 0.7 to 1 W what are the three key measurements for cardiogenic shock? - Correct Ans-PAPI CPO Lactate what is cardiac power output? - Correct Ans-amount of energy available to maintain the perfusion of the vital organs in shock what does lactate in the blood mean and normal value? - Correct Ans-anerobic metabolism is occurring normal is 0.9 to 1.7 what are the two goals of mechanical circulatory support? - Correct Ans-restore adequate end organ perfusion ventricular unloading how does the impella CP work as an LV vent? - Correct Ans-drains at LV and returns at the aortic arch provides 3-3.5 LPM of flow what are the 5 factors affecting pharmacokinetics with critical illness? - Correct Ans-1. augmented cardiac output 2. leaky capillaries 3. volume resusitation 4. end-organ perfusion 5. altered protein binding what is pharmacodynamics? - Correct Ans-the bodys biological response to the drug what are the factors 5 affecting pharmacokinetics with ECMO? - Correct Ans-1. augmented cardiac output 2. leaky capillaries 3. end-organ perfusion 4. hemodilution 5. drug sequestration which drugs should you avoid with ecmo? - Correct Ans-benzos!!! lipophillic and sequester in the tubing why do we need anticoagulation on ecmo? - Correct Ans-blood contacts the ecmo circuit causing a sirs response and leads to: inflammation/vasodilation coagulation altered fibrinolysis how does heparin work? - Correct Ans-Activates antithrombin III - inactivates thrombin, factor IXa, & factor Xa. what are the 3 definitions of ards and how are they defined? - Correct Ans-1. Mild- pf ratio is 200-300 mmhg w/peep or CPAP 5 2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP 5 3. severe- pf ratio is 100 mmhg with peep 5 what are the 3 consequences of lung injury with ards? - Correct Ans-1. impaired gas exchange 2. decreased compliance 3. increased pulmonary arterial pressure what are the two things that happen with impaired gas exchange? - Correct Ans-1. V/Q mismatch - alveolar shunting 2. increased dead space - high minute ventilation and impaired CO2 elimination what is the hallmark sign of ards? - Correct Ans-decreased lung compliance -- due to stiff and poorly or non-aerated lungs what are the three stages of ards? - Correct Ans-1) Exudative- (4-7 days) -- interstitial edema, hyaline membranes, cytokine production, loss of coagulation 2) Proliferative (7-21 days ) -- alveolar and intimal fibrosis and proliferation of type 2 cells and fibroblasts 3) Fibrotic ( 21 days) - extensive pulmonary fibrosis, loss of normal alveolar architecture, emphasematous lungs EPF= Each Pulmonary "F"ase 5 Causes of ards- pulmonary - Correct Ans-1. pneumonia 2. aspiration 3. pulmonary contusion 4. inhalation injury 5. fat emboli 5 causes of ards- extra pulmonary - Correct Ans-1. sepsis 2. trauma 3. drug overdose 4. acute pancreatitis 5. cardiopulmonary bypass 3 ways to manage ards- evidence based - Correct Ans-1. low tidal volume ventilation - 6 ml/kg of ideal body weight 2. conservative fluid management - CVP 4 3. neuromuscular blockades 5 ARDS rescue therapies - Correct Ans-1. Rotaprone -- good evidence 2. HFOV 3. Nitric 4. APRV 5. ECMO -- good evidence 5 steps for ES during insertion - Correct Ans-1. obtain insertion cart 2. build and prime circuit 3. assist MD with cannula placement 4. notify bedside rn when to give heparin and antibiotic dose 5. initiate ECMO therapy what two insertion kits are there and what is the difference in the two? - Correct Ans-PIK-A and PIK-V - both are J tip wires A- 100 cm arterial V- 150 cm venous how much heparin do you give once both wires are in? - Correct Ans-5,000 units what do you verbalize at bedside before flowing during insertion? - Correct Ans-Both hands on cannulas what is the type and size of arterial cannula? - Correct Ans-bullet tip return, common is 21 F but can be 19-25 F non bullet tip return is 19 F what is the type and size of venous cannula? - Correct Ans-multi stage drainage, common is 25 F but can be 21-29 F what is the size of avalon cannula and where do they drain/return? - Correct Ans-common is 31 F but can be 27-31 F dual lumen, drains at svc/ivc and returns at tricuspid How does the protek duo work and where does it drain/ return? - Correct Ans-for RV failure drains RA and returns at PA what is the CI goal for cannula selection? - Correct Ans-2.2 L What is the app called to determine cannula selection? - Correct Ans-Ipump aside from flow, what is the other major component when determining cannula selection? - Correct Ans-pressure drop-- difference in pressure as fluid enters and leaves the cannula goal is 100 mmhg too high = hemolysis what is the priming volume for tubing? - Correct Ans-20 ml what is the priming volume for rotaflow/centrimag? - Correct Ans-32 ml/ 31 ml what is the priming volume for cardiohelp system? - Correct Ans-273 ml what is the priming volume for quadrox oxygenator? - Correct Ans-215 ml what is the total priming volume for ECMO? - Correct Ans-600 ml what are the two major factors regarding flow with centrigual pumps? - Correct Ans-preload dependent, afterload sensitive which ecmo systems have a hand crank? - Correct Ans-rotaflow and cardiohelp what are the gas fibers called in the oxygenator? - Correct Ans-polymethylpentene (PMP) no direct interface with blood and gas and no plasma leak gas travels inside, blood travels outside what is the gas exchange surface area of the oxygenator and normal lung? - Correct Ans-1.8 m2 oxygenator 70 m2 natural lung