ECMO SPECIALIST EXAM ECMO
MANAGEMENT FOR SPECIALISTS EXAM
QUESTIONS WITH VERIFIED SOLUTIONS
NEWLY MODIFIED GRADED A+ TESTED
AND APPROVED!!!2026-2027
what are the 5 factors affecting pharmacokinetics with critical illness? --
ANSWER--1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? -Correct ANS-the bodys biological response to the drug
what are the factors 5 affecting pharmacokinetics with ECMO? -Correct ANS-1. augmented cardiac
output 2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
which drugs should you avoid with ecmo? -Correct ANS-benzos!!! lipophillic and sequester in the
tubing
why do we need anticoagulation on ecmo? -Correct ANS-blood contacts the ecmo circuit causing a
sirs response and leads to:
inflammation/vasodilation coagulation altered fibrinolysis
how does heparin work? -Correct ANS-Activates antithrombin III -> inactivates thrombin, factor
IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? -Correct ANS-1.
Mild- pf ratio is 200-300 mmhg w/peep or CPAP > 5
2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
3. severe- pf ratio is <100 mmhg with peep > 5
what are the 3 consequences of lung injury with ards? -Correct ANS-1. impaired gas exchange
2. decreased compliance
3. increased pulmonary arterial pressure
what are the two things that happen with impaired gas exchange? -Correct ANS-
1. V/Q mismatch - alveolar shunting
2. increased dead space - high minute ventilation and impaired CO2 elimination
,what is the hallmark sign of ards? -Correct ANS-decreased lung compliance -- due to stiff and
poorly or non-aerated lungs
what are the three stages of ards? -Correct ANS-1) Exudative- (4-7 days) -- interstitial edema,
hyaline membranes, cytokine production, loss of coagulation
2) Proliferative (7-21 days ) -- alveolar and intimal fibrosis and proliferation of type 2 cells and
fibroblasts
3) Fibrotic ( >21 days) - extensive pulmonary fibrosis, loss of normal alveolar architecture,
emphasematous lungs
EPF= Each Pulmonary "F"ase
5 Causes of ards- pulmonary -Correct ANS-1. pneumonia
2. aspiration
3. pulmonary contusion
4. inhalation injury
5. fat emboli
5 causes of ards- extra pulmonary -Correct ANS-1. sepsis
2. trauma
3. drug overdose
4. acute pancreatitis
5. cardiopulmonary bypass
3 ways to manage ards- evidence based -Correct ANS-1. low tidal volume ventilation - 6 ml/kg of
ideal body weight
2. conservative fluid management - CVP < 4
3. neuromuscular blockades
How to recognize cardiogenic shock? (acronym) -Correct ANS-CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) -Correct ANS-(ECLS )
ECG
Consult- surgeon
Labs- lactates, abgs etc.
Swan catheter
what is PAPI score? Formula and normal value -Correct ANS-differentiates between the LV/RV
disfunction, if low = RV dysfunction
PAPi= (sPAP-dPAP)/RA
it is the pa sys - the pa dyastolic / right atrial pressure- can get these numbers from swan normal is >1.0
,Formula for cardiac power output (CPO) and normal value -Correct ANS-CPO=
MAP x CO/451
normal = 0.7 to 1 W
what are the three key measurements for cardiogenic shock? -Correct ANS-PAPI
CPO
Lactate
what is cardiac power output? -Correct ANS-amount of energy available to maintain the perfusion of
the vital organs in shock
what does lactate in the blood mean and normal value? -Correct ANS-anerobic metabolism is
occurring
normal is 0.9 to 1.7
what are the two goals of mechanical circulatory support? -Correct ANS-restore adequate end organ
perfusion
ventricular unloading
how does the impella CP work as an LV vent? -Correct ANS-drains at LV and returns at the aortic
arch
provides 3-3.5 LPM of flow
5 ARDS rescue therapies -Correct ANS-1. Rotaprone -- good evidence
2. HFOV
3. Nitric
4. APRV
5. ECMO -- good evidence
5 steps for ES during insertion -Correct ANS-1. obtain insertion cart
2. build and prime circuit
3. assist MD with cannula placement
4. notify bedside rn when to give heparin and antibiotic dose
5. initiate ECMO therapy
what two insertion kits are there and what is the difference in the two? --
ANSWER--PIK-A and PIK-V - both are J tip wires
A- 100 cm arterial
V- 150 cm venous
how much heparin do you give once both wires are in? -Correct ANS-5,000 units
, what do you verbalize at bedside before flowing during insertion? --ANSWER-Both hands on cannulas
what is the type and size of arterial cannula? -Correct ANS-bullet tip return, common is 21 F but can
be 19-25 F non bullet tip return is 19 F
what is the type and size of venous cannula? -Correct ANS-multi stage drainage, common is 25 F
but can be 21-29 F
what is the size of avalon cannula and where do they drain/return? --ANSWER-
-common is 31 F but can be 27-31 F dual lumen, drains at svc/ivc and returns at tricuspid
How does the protek duo work and where does it drain/ return? --ANSWER-for RV failure drains RA
and returns at PA
what is the CI goal for cannula selection? -Correct ANS-2.2 L
What is the app called to determine cannula selection? -Correct ANS-Ipump
aside from flow, what is the other major component when determining cannula selection? -Correct
ANS-pressure drop-- difference in pressure as fluid enters and leaves the cannula goal is 100 mmhg
too high = hemolysis
what is the priming volume for tubing? -Correct ANS-20 ml
what is the priming volume for rotaflow/centrimag? -Correct ANS-32 ml/ 31 ml what is the priming
volume for cardiohelp system? -Correct ANS-273 ml
what is the priming volume for quadrox oxygenator? -Correct ANS-215 ml
what is the total priming volume for ECMO? -Correct ANS-600 ml
what are the two major factors regarding flow with centrigual pumps? --
ANSWER--preload dependent, afterload sensitive
which ecmo systems have a hand crank? -Correct ANS-rotaflow and cardiohelp
what are the gas fibers called in the oxygenator? --ANSWER-polymethylpentene (PMP) no direct
interface with blood and gas and no plasma leak gas travels inside, blood travels outside
what is the gas exchange surface area of the oxygenator and normal lung? --
ANSWER--1.8 m2 oxygenator
70 m2 natural lung
what are the water fibers called? -Correct ANS-polyurethane
how do you increase oxygenation in the ECMO world? -Correct ANS-1. increase
MANAGEMENT FOR SPECIALISTS EXAM
QUESTIONS WITH VERIFIED SOLUTIONS
NEWLY MODIFIED GRADED A+ TESTED
AND APPROVED!!!2026-2027
what are the 5 factors affecting pharmacokinetics with critical illness? --
ANSWER--1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? -Correct ANS-the bodys biological response to the drug
what are the factors 5 affecting pharmacokinetics with ECMO? -Correct ANS-1. augmented cardiac
output 2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
which drugs should you avoid with ecmo? -Correct ANS-benzos!!! lipophillic and sequester in the
tubing
why do we need anticoagulation on ecmo? -Correct ANS-blood contacts the ecmo circuit causing a
sirs response and leads to:
inflammation/vasodilation coagulation altered fibrinolysis
how does heparin work? -Correct ANS-Activates antithrombin III -> inactivates thrombin, factor
IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? -Correct ANS-1.
Mild- pf ratio is 200-300 mmhg w/peep or CPAP > 5
2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
3. severe- pf ratio is <100 mmhg with peep > 5
what are the 3 consequences of lung injury with ards? -Correct ANS-1. impaired gas exchange
2. decreased compliance
3. increased pulmonary arterial pressure
what are the two things that happen with impaired gas exchange? -Correct ANS-
1. V/Q mismatch - alveolar shunting
2. increased dead space - high minute ventilation and impaired CO2 elimination
,what is the hallmark sign of ards? -Correct ANS-decreased lung compliance -- due to stiff and
poorly or non-aerated lungs
what are the three stages of ards? -Correct ANS-1) Exudative- (4-7 days) -- interstitial edema,
hyaline membranes, cytokine production, loss of coagulation
2) Proliferative (7-21 days ) -- alveolar and intimal fibrosis and proliferation of type 2 cells and
fibroblasts
3) Fibrotic ( >21 days) - extensive pulmonary fibrosis, loss of normal alveolar architecture,
emphasematous lungs
EPF= Each Pulmonary "F"ase
5 Causes of ards- pulmonary -Correct ANS-1. pneumonia
2. aspiration
3. pulmonary contusion
4. inhalation injury
5. fat emboli
5 causes of ards- extra pulmonary -Correct ANS-1. sepsis
2. trauma
3. drug overdose
4. acute pancreatitis
5. cardiopulmonary bypass
3 ways to manage ards- evidence based -Correct ANS-1. low tidal volume ventilation - 6 ml/kg of
ideal body weight
2. conservative fluid management - CVP < 4
3. neuromuscular blockades
How to recognize cardiogenic shock? (acronym) -Correct ANS-CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) -Correct ANS-(ECLS )
ECG
Consult- surgeon
Labs- lactates, abgs etc.
Swan catheter
what is PAPI score? Formula and normal value -Correct ANS-differentiates between the LV/RV
disfunction, if low = RV dysfunction
PAPi= (sPAP-dPAP)/RA
it is the pa sys - the pa dyastolic / right atrial pressure- can get these numbers from swan normal is >1.0
,Formula for cardiac power output (CPO) and normal value -Correct ANS-CPO=
MAP x CO/451
normal = 0.7 to 1 W
what are the three key measurements for cardiogenic shock? -Correct ANS-PAPI
CPO
Lactate
what is cardiac power output? -Correct ANS-amount of energy available to maintain the perfusion of
the vital organs in shock
what does lactate in the blood mean and normal value? -Correct ANS-anerobic metabolism is
occurring
normal is 0.9 to 1.7
what are the two goals of mechanical circulatory support? -Correct ANS-restore adequate end organ
perfusion
ventricular unloading
how does the impella CP work as an LV vent? -Correct ANS-drains at LV and returns at the aortic
arch
provides 3-3.5 LPM of flow
5 ARDS rescue therapies -Correct ANS-1. Rotaprone -- good evidence
2. HFOV
3. Nitric
4. APRV
5. ECMO -- good evidence
5 steps for ES during insertion -Correct ANS-1. obtain insertion cart
2. build and prime circuit
3. assist MD with cannula placement
4. notify bedside rn when to give heparin and antibiotic dose
5. initiate ECMO therapy
what two insertion kits are there and what is the difference in the two? --
ANSWER--PIK-A and PIK-V - both are J tip wires
A- 100 cm arterial
V- 150 cm venous
how much heparin do you give once both wires are in? -Correct ANS-5,000 units
, what do you verbalize at bedside before flowing during insertion? --ANSWER-Both hands on cannulas
what is the type and size of arterial cannula? -Correct ANS-bullet tip return, common is 21 F but can
be 19-25 F non bullet tip return is 19 F
what is the type and size of venous cannula? -Correct ANS-multi stage drainage, common is 25 F
but can be 21-29 F
what is the size of avalon cannula and where do they drain/return? --ANSWER-
-common is 31 F but can be 27-31 F dual lumen, drains at svc/ivc and returns at tricuspid
How does the protek duo work and where does it drain/ return? --ANSWER-for RV failure drains RA
and returns at PA
what is the CI goal for cannula selection? -Correct ANS-2.2 L
What is the app called to determine cannula selection? -Correct ANS-Ipump
aside from flow, what is the other major component when determining cannula selection? -Correct
ANS-pressure drop-- difference in pressure as fluid enters and leaves the cannula goal is 100 mmhg
too high = hemolysis
what is the priming volume for tubing? -Correct ANS-20 ml
what is the priming volume for rotaflow/centrimag? -Correct ANS-32 ml/ 31 ml what is the priming
volume for cardiohelp system? -Correct ANS-273 ml
what is the priming volume for quadrox oxygenator? -Correct ANS-215 ml
what is the total priming volume for ECMO? -Correct ANS-600 ml
what are the two major factors regarding flow with centrigual pumps? --
ANSWER--preload dependent, afterload sensitive
which ecmo systems have a hand crank? -Correct ANS-rotaflow and cardiohelp
what are the gas fibers called in the oxygenator? --ANSWER-polymethylpentene (PMP) no direct
interface with blood and gas and no plasma leak gas travels inside, blood travels outside
what is the gas exchange surface area of the oxygenator and normal lung? --
ANSWER--1.8 m2 oxygenator
70 m2 natural lung
what are the water fibers called? -Correct ANS-polyurethane
how do you increase oxygenation in the ECMO world? -Correct ANS-1. increase
