ECMO SPECIALIST TEST QUESTIONS
AND ANSWERS
This ECMO phenomenon occurs during peripheral V-A ECMO when cardiac function
has recovered but lung function remains impaired - Answer- Differential hypoxemia/
north south syndrome/ harlequin syndrome
This type of ECMO results in integrate blood flow - Answer- Central cannulation
A patient with this type of shunt/defect is likely to have decreased patient PO2 - Answer-
A Right to left shunt
This medication is the reversal agent for heparin and should be used cautiously during
ECMO - Answer- Protamine
What is the appropriate time to check an ACT before cannulation - Answer- 3-5 minutes
after the heparin bolus
Increases in this hemodynamic may be a predictor of cardiac improvement - Answer-
arterial pulse pressure
What is recirculation - Answer- Proximity of drainage and return cannula and/or high
ECBF can result in this inefficiency of V-V ECMO which can cause increased circuit
SvO2 and decreased pt. SaO2
Addition of a 2nd or third drainage cannula to address the inability to capture enough
blood for effective ECBF could remedy what condition on V-V ECMO? - Answer-
Refractory hypoxemia on ECMO
When are ECMO rounds - Answer- Thursdays at 2pm
What is Delta P? - Answer- Expression of the pressure drop across the oxygenator
VV ECMO - Answer- Can be though of as "IV gas exchange" aims to deliver enough
oxygen to support end-organ perfusion.
ECMO directors - Answer- Dr. Devaleria & Dr. Sen
Extracorporeal Life Support Organization (ELSO) - Answer- A Consortium developed in
1989 that defines ECMO guidelines and maintains a registry of all ECMO patients
, Contraindications to V-V ECMO - Answer- Cardiogenic Shock, chronic respiratory
failure, uncontrolled sepsis and multi-organ failure
Father of ECMO? What does he believe? - Answer- Dr Robert Bartlett; he believes al
patients should have a Hgb of 15g/dL
Test to confirm Hemolysis - Answer- lactate dehydrogenase (LDH) and plasma free
Hemoglobin (sent out ever 3 days plasma free hgb)
Air Entrainment - Answer- This originates from the pre-pump side of the circuit, will
seize a centrifugal pump, and requires rapid assessment for the source. Specialist
much watch closely, and prepare to clamp oxygenator outflow (ECMO Arterial)
Chatter - Answer- This colloquialism is intermittent venous line obstruction that causes
variable ECBF (Ecmo Cannula bloodflow).
Arterial Decannulation - Answer- This Emergency will result in rapid exsanguination,
Clamp the outflow immediately
Low Flow/No Flow - Answer- The inability of the centrifugal pump to generate output.
Remedied by reducing pump speed.
VV ECMO blood gas optimization is titrated according to - Answer- Pt.'s arterial blood
gas
Signs of Oxygenator Failure - Answer- increasing Delta P
increasing ECMO PCO2 despite increased sweep on blender
Decreasing ECMO PO2 despite increased FIO2 on the blender
Bioderm Cath Grips and CHG Tegaderm are changed? - Answer- Every 7 days
Hourly ECMO monitoring and Assessment Requirements include - Answer- Circuit
check
Cannulae site assessment
Circuit pressure /flow/blender settings
N/V assessment of cannulated limbs.
Type and screen - Answer- This is done every 3 days and must remain up to date entire
time patient is on ECLS
Roller Pump - Answer- Has no sensitivity to afterload
What directly controls CO2 removal and FIO2 - Answer- Air/ oxygen gas blender
AND ANSWERS
This ECMO phenomenon occurs during peripheral V-A ECMO when cardiac function
has recovered but lung function remains impaired - Answer- Differential hypoxemia/
north south syndrome/ harlequin syndrome
This type of ECMO results in integrate blood flow - Answer- Central cannulation
A patient with this type of shunt/defect is likely to have decreased patient PO2 - Answer-
A Right to left shunt
This medication is the reversal agent for heparin and should be used cautiously during
ECMO - Answer- Protamine
What is the appropriate time to check an ACT before cannulation - Answer- 3-5 minutes
after the heparin bolus
Increases in this hemodynamic may be a predictor of cardiac improvement - Answer-
arterial pulse pressure
What is recirculation - Answer- Proximity of drainage and return cannula and/or high
ECBF can result in this inefficiency of V-V ECMO which can cause increased circuit
SvO2 and decreased pt. SaO2
Addition of a 2nd or third drainage cannula to address the inability to capture enough
blood for effective ECBF could remedy what condition on V-V ECMO? - Answer-
Refractory hypoxemia on ECMO
When are ECMO rounds - Answer- Thursdays at 2pm
What is Delta P? - Answer- Expression of the pressure drop across the oxygenator
VV ECMO - Answer- Can be though of as "IV gas exchange" aims to deliver enough
oxygen to support end-organ perfusion.
ECMO directors - Answer- Dr. Devaleria & Dr. Sen
Extracorporeal Life Support Organization (ELSO) - Answer- A Consortium developed in
1989 that defines ECMO guidelines and maintains a registry of all ECMO patients
, Contraindications to V-V ECMO - Answer- Cardiogenic Shock, chronic respiratory
failure, uncontrolled sepsis and multi-organ failure
Father of ECMO? What does he believe? - Answer- Dr Robert Bartlett; he believes al
patients should have a Hgb of 15g/dL
Test to confirm Hemolysis - Answer- lactate dehydrogenase (LDH) and plasma free
Hemoglobin (sent out ever 3 days plasma free hgb)
Air Entrainment - Answer- This originates from the pre-pump side of the circuit, will
seize a centrifugal pump, and requires rapid assessment for the source. Specialist
much watch closely, and prepare to clamp oxygenator outflow (ECMO Arterial)
Chatter - Answer- This colloquialism is intermittent venous line obstruction that causes
variable ECBF (Ecmo Cannula bloodflow).
Arterial Decannulation - Answer- This Emergency will result in rapid exsanguination,
Clamp the outflow immediately
Low Flow/No Flow - Answer- The inability of the centrifugal pump to generate output.
Remedied by reducing pump speed.
VV ECMO blood gas optimization is titrated according to - Answer- Pt.'s arterial blood
gas
Signs of Oxygenator Failure - Answer- increasing Delta P
increasing ECMO PCO2 despite increased sweep on blender
Decreasing ECMO PO2 despite increased FIO2 on the blender
Bioderm Cath Grips and CHG Tegaderm are changed? - Answer- Every 7 days
Hourly ECMO monitoring and Assessment Requirements include - Answer- Circuit
check
Cannulae site assessment
Circuit pressure /flow/blender settings
N/V assessment of cannulated limbs.
Type and screen - Answer- This is done every 3 days and must remain up to date entire
time patient is on ECLS
Roller Pump - Answer- Has no sensitivity to afterload
What directly controls CO2 removal and FIO2 - Answer- Air/ oxygen gas blender
