ECMO study questions and answers

ECMO study questions and answers

What are 3 factors that affect oxygen delivery? - answer-- Hemoglobin
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- Cardiac Output / ECMO flow
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- Oxygen saturation
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Key term for VA-ECMO? - answer-Partial bypass
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Key term for VV-ECMO? - answer-Partial capture
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On which type of ECMO do you run a full code (with compression)? - answer-VV-ECMO
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Which ECMO requires full drugs per ACLS but no compressions in a code? - answer-
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VA-ECMO

mL in an ECMO circuit? - answer-800mL
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mL in an ECMO circuit + CVVHD? - answer-1100mL
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In which type of ECMO is SvO2 utilized? - answer-VA-ECMO
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What are the "3 C's" in an ECMO emergency? - answer-- Clamp
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- Call for help
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- Compensate for losses in support with drugs and other measures
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What is the default anticoagulant used in ECLS? - answer-Heparin
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What are the actions of heparin? - answer-- Accelerates the action of endogenous
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vantithrombin.
- Inhibits thrombin and factor Xa
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What is the normal dose of heparin given at the time of ECMO cannulation? - answer-50
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- 100 units / kg
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What blood product is indicated for patients who are heparin resistant 2/2 diminshed
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antithrombin levels? - answer-FFP
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What is the standard goal aPTT for ECMO patients being heparinized? - answer-50 - 75
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Clotting that occurs when blood comes into contact with a non-endothelial surface -
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answer-Intrinsic pathway
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, Clotting that occurs by the release of tissue factor from damaged tissue - answer-
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Extrinsic pathway v




Current survivial rate of patients put on ECMO for cardiac reasons? - answer-23 - 71%
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What are some contraindications to ECMO? - answer-- End-stage, irreversible, or
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vinoperable cardiac disease. v v


- Significant neurological or end-stage renal impairment.
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- Uncontrolled bleeding of major organs.
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- Extremes of size or weight (relative)
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- Inaccessible vessels during CPR (though femoral is usually accessible)
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Placement options for venous drainage of VV-ECMO? - answer-- Femoral Vein
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- R IJ (if an Avalon Cannula)
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Both drain venous blood from the SVC
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Placement options for return blood of VV-ECMO? - answer-- Right IJ
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- Right Axillary vein
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- Right Subclavian vein
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All terminate in the RA with the outflow directed at the Tricuspid valve.
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What percentage of cardiac output is provided by VV-ECMO? - answer-0%
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What percentage of cardiac output can be provided by VA-ECMO? - answer-60 - 80%
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Cannulation sites for venous drainage in VA-ECMO? - answer-- Femoral vein
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- Right IJ
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Both terminate in the SVC
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Cannulation sites for arterial (return) cannula? - answer-- Femoral artery
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- Axillary artery
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- Carotid artery
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- Transthoracic (direct) cannulation
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When "resting the lungs" with VV-ECMO, what are common ventilator settings? -
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answer-RR <10 (We will allow permissive hypercapnea while resting)
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Long inspiratory times (i:e)
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Low inspiratory pressures (< 25 cmH2O)
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Low Tidal Volumes
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Standard PEEP (high PEEP can inhibit venous return)
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Low FiO2 (<30%) v v




Indications for VV-ECMO - answer-Severe pneumonia v v v v v