ECMO Specialist Exam questions with complete solutions

ECMO Specialist Exam questions with
complete solutions



How to recognize cardiogenic shock? (acronym) - answer-CS-MODE
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Cardiac Rhythm v v


SBP <90 v v


Markers- cardiac v v


Output- oliguria v v


Drips - Inotropes/ pressers
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Exam - cool, clammy, resp distress
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How to diagnose shock ( acronym) - answer-(ECLS )
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ECG v


Consult- surgeon v v


Labs- lactates, abgs etc.
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Swan catheter v




what is PAPI score? Formula and normal value - answer-differentiates between the
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LV/RV disfunction, if low = RV dysfunction
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PAPi= (sPAP-dPAP)/RA v


it is the pa sys - the pa dyastolic / right atrial pressure- can get these numbers from swan
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normal is >1.0 v v




Formula for cardiac power output (CPO) and normal value - answer-CPO= MAP x
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CO/451
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normal = 0.7 to 1 W v v v v v




what are the three key measurements for cardiogenic shock? - answer-PAPI
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CPO v


Lactate

what is cardiac power output? - answer-amount of energy available to maintain the
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perfusion of the vital organs in shock
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what does lactate in the blood mean and normal value? - answer-anerobic metabolism is
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occurring
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, normal is 0.9 to 1.7 v v v v




what are the two goals of mechanical circulatory support? - answer-restore adequate
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end organ perfusion
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ventricular unloading v




how does the impella CP work as an LV vent? - answer-drains at LV and returns at the
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aortic arch
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provides 3-3.5 LPM of flow v v v v




what are the 5 factors affecting pharmacokinetics with critical illness? - answer-1.
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augmented cardiac output
v v v


2. leaky capillaries
v v v


3. volume resusitation
v v v


4. end-organ perfusion
v v v


5. altered protein binding
v v v




what is pharmacodynamics? - answer-the bodys biological response to the drug
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what are the factors 5 affecting pharmacokinetics with ECMO? - answer-1. augmented
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cardiac output
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2. leaky capillaries
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3. end-organ perfusion
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4. hemodilution
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5. drug sequestration
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which drugs should you avoid with ecmo? - answer-benzos!!! lipophillic and sequester in
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the tubing
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why do we need anticoagulation on ecmo? - answer-blood contacts the ecmo circuit
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vcausing a sirs response and leads to:
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inflammation/vasodilation v


coagulation v


altered fibrinolysis v




how does heparin work? - answer-Activates antithrombin III -> inactivates thrombin,
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factor IXa, & factor Xa.
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what are the 3 definitions of ards and how are they defined? - answer-1. Mild- pf ratio is
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200-300 mmhg w/peep or CPAP > 5
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2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
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3. severe- pf ratio is <100 mmhg with peep > 5
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