ECMO Specialist Test Review questions weith complete solutions

ECMO Specialist Test Review
questions weith complete solutions


Who is the 'father' of ECMO? - answer-Robert Bartlett
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First successful neonate ECMO run? - answer-Esperanza in 1975
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How does gas exchange occur at the alveoli and pulmonary capillaries? - answer-
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Diffusion (area of higher concentration to an area of lower concentration)
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How fast does gas exchange occur at the alveoli and pulmonary capillaries? - answer-
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3/4 of a second
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What are the 4 components of oxygen delivery? - answer-1. Cardiac Output
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2. Hemoglobin Concentration
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3. Hemoglobin Saturation
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4. Dissolved Oxygen
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Ideal DO2/VO2 Ratio? - answer-4:1
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What is the metabolic rate of the heart? - answer-The heart consumes 70-75% of the
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oxygen it is supplied
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What determines VO2? - answer-1. Cell Metabolism
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2. Mass and Activity
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3. Thyroid, Hypothalamus, and Catecholamines
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Facts about SVO2: - answer-- Measures global O2 consumption and utilization
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- Normal is 65-75%
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- SvO2 = DO2-VO2
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- <50% will lead to anaerobic metabolism (lactic acid production)
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Oxygenation is controlled by: (gas exchange with membrane lung) - answer-- The
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vamount of O2 added to the inlet blood (Starting CaO2)
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- Blood Flow
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- Surface Area
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- Rated flow (tested in lab)
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CO2 is controlled by: (gas exchange with membrane lung) - answer-- Sweep gas flow
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- Percent of O2 in sweep gas
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, - Surface area
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Oxygen/CO2 Transport: - answer-- 98.5% of oxygen is bound to hemoglobin; 1.5% is
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vdissolved in the plasma v v v


- HCO3 60%, carbaminohemoglobin 30%, dissolved in plasma 10%
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CaO2 Formula - answer-CaO2 = [(Hgb x 1.34) x SaO2] + [PaO2 x 0.003]
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Use decimal for SaO2 only
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Normal is 20mL/dL (>15 mL/dL is GREAT for ICU patients)
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DO2 Formula - answer-CaO2 x 10 x CO
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Normal is 1000 mL/min v v v


With VA ECMO use total CO (native + ECMO flow for calculation)
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With VV ECMO use total CO (calculate with CO for VV ECMO formula)
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VO2 Formula - answer-CO (SaO2-SvO2) x Hgb x 1.34 x 10
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Turn SaO2 and SvO2 into decimals
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Normal 200-250 mL/min v v


With VA ECMO use only native CO for calculation (obtained from FICK)
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With VV ECMO use total CO (obtained from CO for VV ECMO Calculation)
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SvO2 Forumla - answer-DO2-VO2
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DO2:VO2 Ratio - answer-DO2/VO2 v v v




Calculating CO in VV ECMO - answer-ECMO Flow x [(S1-S2)/(S3-S2)]
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No decimals
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S1 =ECMO Arterial Sat (Should be 100%)
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S2 =Patient Venous Sat
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S3 =Patient Arterial Sat
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How do we control DO2 on ECMO? - answer--ECMO Flow
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-Hgb
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Most used cannula sizes (unless BSA <1.6) - answer-Venous: 25fr (5-6 L/min)
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Arterial: 19fr (4.5-5.5 L/min) v v v


Crescent: 32fr (17F return) v v v




Arterial Pressure Drop - answer--Goal to be <100mmHg @ max expected flow
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- Ex. Need to flow 5l/min? Need 20fr return cannula
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Ideal ECMO Flow Formula: - answer-BSA x 2.2 (the desired CL on 4R)
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Centrifugal Pump Basics - answer-- Preload dependentv v v v v v


- Afterload sensitive
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