ECMO SPECIALIST TRAINING
MANUAL QUESTIONS CASE STUDIES
CH 1-9 LATEST UPDATE 2025-2026
1. Oxygen content depends on which of the following?
a. Hemoglobin concentration
b. Patient temperature
c. Dissolved oxygen
d. PaO2
e. PaCO2
Ch2.
1. a, d, e
2. Which of the following is true of the arterial-venous oxygen difference (A-V
DO2)?
a. Depends on oxygen delivery.
b. Is reflected in circuit venous saturation with VA-ECMO
c. Can be decreased by increasing sweep gas flow
d. Depends only on ECMO pump flow
e. May be decreased by cooling a patient
Ch2
2. a, b, e
a. Depends on oxygen delivery.
b. Is reflected in circuit venous saturation with VA-ECMO
c. Can be decreased by increasing sweep gas flow
d. Depends only on ECMO pump flow
e. May be decreased by cooling a patient
3. Factors that increase tissue unloading of oxygen include which of the
following?
a. An increase in pH
b. An increase in 2, 3 bisphosphoglycerate
c. A decrease in patient temperature
d. A decrease in PCO2
Ch2
B
4. Improved oxygen delivery of a patient receiving ECLS can occur with a. Young
circuitb. Improvement in native lung function.c. Increased pump flow with
venovenous ECLS.
d. Increasing pump flow above the rated flow of the oxygenator
Ch2
b, c (There is usually a limit to how much
increasing pump flow improves oxygen de- livery because at some point the increase in
recirculation that occurs with increases in flow outweighs the improvement in forward
flow.)
,5. Carbon dioxide clearance by the ECLS pump in influenced by a. Pre-
oxygenator bicarbonate concentrationb. Sweep gas flowc. Membrane surface
area
d. Sweep gas O2 concentration e. Sweep gas CO2
Ch 2, 5
b, c, e
Which of the following is NOT a direct determinant of oxygen delivery to the
tissues? a. Cardiac outputb. Hemoglobinc. Arterial oxygen saturation
d. Central venous pressure
Ch 3, 1
d
Ejection of blood from the heart is considered afterload _________ and preload
_________. a. Dependent ; dependentb. Sensitive ; dependentc. Sensitive ;
sensitive
d. Dependent ; sensitive
Ch 3
2. b
Which of the following can be used as a tool to assess adequacy of perfusion? a.
Tissue oximetryb. Serum lactate concentrationc. Venous oxygen saturation
d. All of the above
Ch 3
3. d
VA-ECMO increases afterload to the: a. Right ventricleb. Left ventriclec. Both
d. Neither
Ch 3
4. b
The cardiac output curve can be affected by afterload, contractility and heart rate.
Assuming that vascular resistance does not change, cardiac output is also
related to:a. Hemoglobinb. Central venous pressure (CVP)
c. Vessel radius d. PaO2
Ch 3
5. b
In order to safely insert the venovenous cannulae, the surgical team wishes for
her platelet count to be above 30k/dL. What is the appropriate dose and
modifications?a. 20 ml/kg of irradiated platelets should increase her platelet
count by 20,000/dLb. 10 ml/kg of irradiated platelets should increase her platelet
count by 30,000/dL
c. 1 unit of irradiated platelets should increase her platelet count by 50,000/dLd.
10 ml/kg of non-irradiated platelets should increase her platelet count by
10,000/dL
Ch 5, 1
B
Which of the following is the mechanism of irradiation performed on cellular
blood products? a. Breaks DNA in leukocytes so they cannot proliferate in an
immunocompromised recipient
b. Kills cytomegalovirus (CMV) so that it cannot infect an immunocompromised
, recipient
c. Kills any bacteria in platelet units since they are at such high risk of being
contaminated
d. Removes cytokines thereby preventing febrile non-hemolytic transfusion
reactions
Ch 5, 2
a
What blood type of platelets will be compatible with this patient's blood type? a.
Group O/RhD positiveb. Group B/RhD positivec. Group O/RhD negative
d. Group AB/RhD positive
Ch 5, 3
D (Table 5-3)
The PICU team also wishes to increase her oxygen carrying capacity with one
15ml/kg RBC transfu- sion. The appropriate unit and dose are ordered and the
unit is delivered. You notice that the unit was collected one month ago and will
expire in 10 days. What should you do?
a. Send the unit back since it is old and older blood has been shown to increase
mortality
b. Send the unit back since it is old and older blood has been shown to increase
transfusion reactions
c. Follow hospital transfusion policy to transfuse her the blood since older blood
has not been shown to change clinical outcomes
d. Throw the blood away and request that a fresh unit be delivered
Ch 5 4
4. C
Calculate the oxygenation index for Baby C who is currently on HFOV with a MAP
of 16, Amp of 42, Hz of 8 and 100%. Blood gas results as 7.16/52/32/-8a. 32b. 45
c. 50 d. 64
Ch 7 , 1
1. c (OI = (MAP x FiO2)/PaO2. (16x1x100)/32=50)
This patient is a reasonable candidate for ECMO, but has several risk factors that
increase the odds of morbidity and mortality. Which of the following is NOT a risk
factor?a. Acidosisb. History of CPR
c. Gestational aged. Chronological age e. Diagnosis
Ch 7, 2
d (Late prematurity, history of CPR and aci- dosis are all risk factors for poor outcome,
as is his diagnosis—which is currently id- iopathic PPHN but may also be pneumonia or
"other")
Calculate the oxygenation index for Baby C who is currently on HFOV with a MAP
of 16, Amp of 42, Hz of 8 and 100%. Blood gas results as 7.16/52/32/-8a. 32b. 45
c. 50 d. 64
This patient is a reasonable candidate for ECMO, but has several risk factors that
increase the odds of morbidity and mortality. Which of the following is NOT a risk
factor?a. Acidosisb. History of CPR
c. Gestational aged. Chronological age e. Diagnosis
MANUAL QUESTIONS CASE STUDIES
CH 1-9 LATEST UPDATE 2025-2026
1. Oxygen content depends on which of the following?
a. Hemoglobin concentration
b. Patient temperature
c. Dissolved oxygen
d. PaO2
e. PaCO2
Ch2.
1. a, d, e
2. Which of the following is true of the arterial-venous oxygen difference (A-V
DO2)?
a. Depends on oxygen delivery.
b. Is reflected in circuit venous saturation with VA-ECMO
c. Can be decreased by increasing sweep gas flow
d. Depends only on ECMO pump flow
e. May be decreased by cooling a patient
Ch2
2. a, b, e
a. Depends on oxygen delivery.
b. Is reflected in circuit venous saturation with VA-ECMO
c. Can be decreased by increasing sweep gas flow
d. Depends only on ECMO pump flow
e. May be decreased by cooling a patient
3. Factors that increase tissue unloading of oxygen include which of the
following?
a. An increase in pH
b. An increase in 2, 3 bisphosphoglycerate
c. A decrease in patient temperature
d. A decrease in PCO2
Ch2
B
4. Improved oxygen delivery of a patient receiving ECLS can occur with a. Young
circuitb. Improvement in native lung function.c. Increased pump flow with
venovenous ECLS.
d. Increasing pump flow above the rated flow of the oxygenator
Ch2
b, c (There is usually a limit to how much
increasing pump flow improves oxygen de- livery because at some point the increase in
recirculation that occurs with increases in flow outweighs the improvement in forward
flow.)
,5. Carbon dioxide clearance by the ECLS pump in influenced by a. Pre-
oxygenator bicarbonate concentrationb. Sweep gas flowc. Membrane surface
area
d. Sweep gas O2 concentration e. Sweep gas CO2
Ch 2, 5
b, c, e
Which of the following is NOT a direct determinant of oxygen delivery to the
tissues? a. Cardiac outputb. Hemoglobinc. Arterial oxygen saturation
d. Central venous pressure
Ch 3, 1
d
Ejection of blood from the heart is considered afterload _________ and preload
_________. a. Dependent ; dependentb. Sensitive ; dependentc. Sensitive ;
sensitive
d. Dependent ; sensitive
Ch 3
2. b
Which of the following can be used as a tool to assess adequacy of perfusion? a.
Tissue oximetryb. Serum lactate concentrationc. Venous oxygen saturation
d. All of the above
Ch 3
3. d
VA-ECMO increases afterload to the: a. Right ventricleb. Left ventriclec. Both
d. Neither
Ch 3
4. b
The cardiac output curve can be affected by afterload, contractility and heart rate.
Assuming that vascular resistance does not change, cardiac output is also
related to:a. Hemoglobinb. Central venous pressure (CVP)
c. Vessel radius d. PaO2
Ch 3
5. b
In order to safely insert the venovenous cannulae, the surgical team wishes for
her platelet count to be above 30k/dL. What is the appropriate dose and
modifications?a. 20 ml/kg of irradiated platelets should increase her platelet
count by 20,000/dLb. 10 ml/kg of irradiated platelets should increase her platelet
count by 30,000/dL
c. 1 unit of irradiated platelets should increase her platelet count by 50,000/dLd.
10 ml/kg of non-irradiated platelets should increase her platelet count by
10,000/dL
Ch 5, 1
B
Which of the following is the mechanism of irradiation performed on cellular
blood products? a. Breaks DNA in leukocytes so they cannot proliferate in an
immunocompromised recipient
b. Kills cytomegalovirus (CMV) so that it cannot infect an immunocompromised
, recipient
c. Kills any bacteria in platelet units since they are at such high risk of being
contaminated
d. Removes cytokines thereby preventing febrile non-hemolytic transfusion
reactions
Ch 5, 2
a
What blood type of platelets will be compatible with this patient's blood type? a.
Group O/RhD positiveb. Group B/RhD positivec. Group O/RhD negative
d. Group AB/RhD positive
Ch 5, 3
D (Table 5-3)
The PICU team also wishes to increase her oxygen carrying capacity with one
15ml/kg RBC transfu- sion. The appropriate unit and dose are ordered and the
unit is delivered. You notice that the unit was collected one month ago and will
expire in 10 days. What should you do?
a. Send the unit back since it is old and older blood has been shown to increase
mortality
b. Send the unit back since it is old and older blood has been shown to increase
transfusion reactions
c. Follow hospital transfusion policy to transfuse her the blood since older blood
has not been shown to change clinical outcomes
d. Throw the blood away and request that a fresh unit be delivered
Ch 5 4
4. C
Calculate the oxygenation index for Baby C who is currently on HFOV with a MAP
of 16, Amp of 42, Hz of 8 and 100%. Blood gas results as 7.16/52/32/-8a. 32b. 45
c. 50 d. 64
Ch 7 , 1
1. c (OI = (MAP x FiO2)/PaO2. (16x1x100)/32=50)
This patient is a reasonable candidate for ECMO, but has several risk factors that
increase the odds of morbidity and mortality. Which of the following is NOT a risk
factor?a. Acidosisb. History of CPR
c. Gestational aged. Chronological age e. Diagnosis
Ch 7, 2
d (Late prematurity, history of CPR and aci- dosis are all risk factors for poor outcome,
as is his diagnosis—which is currently id- iopathic PPHN but may also be pneumonia or
"other")
Calculate the oxygenation index for Baby C who is currently on HFOV with a MAP
of 16, Amp of 42, Hz of 8 and 100%. Blood gas results as 7.16/52/32/-8a. 32b. 45
c. 50 d. 64
This patient is a reasonable candidate for ECMO, but has several risk factors that
increase the odds of morbidity and mortality. Which of the following is NOT a risk
factor?a. Acidosisb. History of CPR
c. Gestational aged. Chronological age e. Diagnosis
