ECMO SPECIALIST EXAM REVIEW
QUESTIONS AND ANSWERS ALL
CORRECT
What is aerobic metabolism? - Answer- creating energy WITH the use of oxygen
What is anaerobic metabolism? - Answer- creating energy WITHOUT the use of oxygen
lactic acid production
What is the supply and demand we need for oxygen delivery? - Answer- 4:1 ratio
(delivery:consumption)
What percentage SvO2 will cause anaerobic metabolism? - Answer- SvO2 < 50%
How does the body compensate whenever there is an imbalance between demand and
supply? What happens if this compensation is not adequate? - Answer- -Increases CO
-Increases DO2
-Redistributes blood flow to vital organs (autoregulation)
Pt will go into anaerobic metabolism.
What is the surface area of the oxygenator vs. a lung? - Answer- -oxygenator surface
area: 1.87 m2
-lung surface area: 50-75 m2
What will cause a decrease in oxygenator surface area? - Answer- clots in oxygenator
6 P's of neurovascular assessment - Answer- Pulselessness
Poikilothermia
Pallor
Pain
Paralysis
Paresthesia's
Desired sweep formula - Answer- desired sweep = known sweep x known CO2 /
desired CO2
PTT goals for VA ECMO - Answer- 50-75
PTT goals for VV ECMO - Answer- 40-60
, appropriate oxygenation on VV ECMO - Answer- PaO2 50-60
SpO2 85-88%
Normal venous O2/pre oxy saturation? - Answer- 40-60%
Post oxy saturation should be...
What should FdO2 be at in order to draw a post oxy? - Answer- >100
100%
Pt must be on what settings in order to wean/do RAMP study on VA ECMO? - Answer-
Flows: 2 LPM
Sweep: 1 LPM
FdO2: 100%
***you never wean FdO2 in VA ECMO bc you have arterial return***
Venous access sites - Answer- Femoral vein
IJ vein
Left subclavian
Right atrium
Pulmonary Artery
Arterial access sites - Answer- Ascending aorta
Femoral artery
Axillary artery
Most common cannula sizes for VA? - Answer- 25 Fr drainage
19 Fr return
What are the two types of bi-caval dual lumen cannulas? - Answer- Avalon (31 Fr)
Crescent (32 Fr....only even number cannula)
What cannula drains from the RA and returns to the PA? - Answer- TandemHeart
Protek Duo Cannula
29 Fr
How much can the protek duo flow? - Answer- 3.9 LPM
How do you determine pt's cannula size? - Answer- 1. Calculate pt's BSA
2. Calculate pt's ideal ECMO flow (BSA x 2.2)
3. Look at cannula flow sheet to see what cannula will flow pt's ideal ECMO flow
What is PAPI and why is it trended? - Answer- Pulmonary Artery Pulsatility Index
identifies pts requiring RVAD support
PAPI formula
QUESTIONS AND ANSWERS ALL
CORRECT
What is aerobic metabolism? - Answer- creating energy WITH the use of oxygen
What is anaerobic metabolism? - Answer- creating energy WITHOUT the use of oxygen
lactic acid production
What is the supply and demand we need for oxygen delivery? - Answer- 4:1 ratio
(delivery:consumption)
What percentage SvO2 will cause anaerobic metabolism? - Answer- SvO2 < 50%
How does the body compensate whenever there is an imbalance between demand and
supply? What happens if this compensation is not adequate? - Answer- -Increases CO
-Increases DO2
-Redistributes blood flow to vital organs (autoregulation)
Pt will go into anaerobic metabolism.
What is the surface area of the oxygenator vs. a lung? - Answer- -oxygenator surface
area: 1.87 m2
-lung surface area: 50-75 m2
What will cause a decrease in oxygenator surface area? - Answer- clots in oxygenator
6 P's of neurovascular assessment - Answer- Pulselessness
Poikilothermia
Pallor
Pain
Paralysis
Paresthesia's
Desired sweep formula - Answer- desired sweep = known sweep x known CO2 /
desired CO2
PTT goals for VA ECMO - Answer- 50-75
PTT goals for VV ECMO - Answer- 40-60
, appropriate oxygenation on VV ECMO - Answer- PaO2 50-60
SpO2 85-88%
Normal venous O2/pre oxy saturation? - Answer- 40-60%
Post oxy saturation should be...
What should FdO2 be at in order to draw a post oxy? - Answer- >100
100%
Pt must be on what settings in order to wean/do RAMP study on VA ECMO? - Answer-
Flows: 2 LPM
Sweep: 1 LPM
FdO2: 100%
***you never wean FdO2 in VA ECMO bc you have arterial return***
Venous access sites - Answer- Femoral vein
IJ vein
Left subclavian
Right atrium
Pulmonary Artery
Arterial access sites - Answer- Ascending aorta
Femoral artery
Axillary artery
Most common cannula sizes for VA? - Answer- 25 Fr drainage
19 Fr return
What are the two types of bi-caval dual lumen cannulas? - Answer- Avalon (31 Fr)
Crescent (32 Fr....only even number cannula)
What cannula drains from the RA and returns to the PA? - Answer- TandemHeart
Protek Duo Cannula
29 Fr
How much can the protek duo flow? - Answer- 3.9 LPM
How do you determine pt's cannula size? - Answer- 1. Calculate pt's BSA
2. Calculate pt's ideal ECMO flow (BSA x 2.2)
3. Look at cannula flow sheet to see what cannula will flow pt's ideal ECMO flow
What is PAPI and why is it trended? - Answer- Pulmonary Artery Pulsatility Index
identifies pts requiring RVAD support
PAPI formula
