ECMO Specialist questions with complete solutions

ECMO Specialist questions with
complete solutions


VV ECMO - answer-Can be though of as "IV gas exchange" aims to deliver enough
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oxygen to support end-organ perfusion.
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ECMO directors - answer-Dr. Devaleria & Dr. Sen
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Extracorporeal Life Support Organization (ELSO) - answer-A Consortium developed in
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1989 that defines ECMO guidelines and maintains a registry of all ECMO patients
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Contraindications to V-V ECMO - answer-Cardiogenic Shock, chronic respiratory failure, v v v v v v v v v


uncontrolled sepsis and multi-organ failure
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Father of ECMO? What does he believe? - answer-Dr Robert Bartlett; he believes al
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patients should have a Hgb of 15g/dL
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Test to confirm Hemolysis - answer-lactate dehydrogenase (LDH) and plasma free
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Hemoglobin (sent out ever 3 days plasma free hgb)
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Air Entrainment - answer-This originates from the pre-pump side of the circuit, will seize
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a centrifugal pump, and requires rapid assessment for the source. Specialist much
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watch closely, and prepare to clamp oxygenator outflow (ECMO Arterial)
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Chatter - answer-This colloquialism is intermittent venous line obstruction that causes
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variable ECBF (Ecmo Cannula bloodflow).
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Arterial Decannulation - answer-This Emergency will result in rapid exsanguination,
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Clamp the outflow immediately
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Low Flow/No Flow - answer-The inability of the centrifugal pump to generate output.
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Remedied by reducing pump speed.
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VV ECMO blood gas optimization is titrated according to - answer-Pt.'s arterial blood gas
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Signs of Oxygenator Failure - answer-increasing Delta P
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increasing ECMO PCO2 despite increased sweep on blender
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Decreasing ECMO PO2 despite increased FIO2 on the blender
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Bioderm Cath Grips and CHG Tegaderm are changed? - answer-Every 7 days
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, Hourly ECMO monitoring and Assessment Requirements include - answer-Circuit check
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Cannulae site assessment v v


Circuit pressure /flow/blender settings
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N/V assessment of cannulated limbs.
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Type and screen - answer-This is done every 3 days and must remain up to date entire
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time patient is on ECLS
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Roller Pump - answer-Has no sensitivity to afterload
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What directly controls CO2 removal and FIO2 - answer-Air/ oxygen gas blender
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Centrifugal pumps - answer-Hardware that provides laminar flow, it is preload
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dependent, and afterload sensitive
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What ECMO access is ideal for mobilization, susceptible to malposition, and more
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technically difficult to place. - answer-Dual lumen /bicaval cannula (aka Crescent/
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Avalon)
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This substance coats the hollow fibers mats of the oxygenator, which has enabled
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ECMO runs to be prolonged while minimizing plasma leakage.: - answer-
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Polymethylpentene (PMP) v




Carbon dioxide - answer-Carried in blood bound to hemoglobins, as bicarbonate ion,
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and is dissolved in plasma
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ECMO Shunt is - answer-This inefficiency of V-V ECMO is lack of functional ECMO
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blood flow compared to the patients native cardiac output resulting in a decreased Sa02
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What is the Oxygen Content Equation - answer-(hgb x sat x 1.34) + (PaO2 x 0.003)
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What is recirculation - answer-Proximity of drainage and return cannula and/or high
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ECBF can result in this inefficiency of V-V ECMO which can cause increased circuit
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SvO2 and decreased pt. SaO2
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Addition of a 2nd or third drainage cannula to address the inability to capture enough
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blood for effective ECBF could remedy what condition on V-V ECMO? - answer-
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Refractory hypoxemia on ECMO v v v




When are ECMO rounds - answer-Thursdays at 2pm
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What is Delta P? - answer-Expression of the pressure drop across the oxygenator
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pINT is what? - answer-On cardiohelp, this parameter is the measurement of post pump,
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pre-oxygenator pressure.
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