ECMO SPECIALIST EXAM
QUESTIONS WITH ALL CORRECT
ANSWERS
What is the delta P? - Answer- transmembrane pressure Ppre- Ppost
trend- should be less than 60
if increasing, clotting occurs
What is the connection order for the CRRT? - Answer- access- closest to the pump
return- closest to the oxygenator (neg side)
What is chattering? - Answer- collapse of the vein around the venous cannula due to
hypovolemia
what is hemolysis, s/s, tx - Answer- breakdown of red blood cells
hematuria and elevated plasma free hgb
decrease RPM's, transfuse
What do six things do you take when you travel with ECMO? - Answer- 1. hand crank
2. clamps x 4
3. emergency meds
4. volume - albumin/ LR
5. back up O2 tank
6. battery fully charged
What do you do with ECMO during swan insertion? - Answer- turn down flows!!
what do you do with ecmo for echos? - Answer- decrease flow to 2 lpm
list 10 safety checks that need performed q4h - Answer- 1. verify all electrical cords are
plugged into the red outlet
2. verify wall oxygen and medical air blender is plugged into wall
3. ensure there is at least on full O2 tank available in ECMO cart
4. ensure the gas line from blender is connected to oxygenator
5. ensure the emergency hand crank is in the ECMO pump cart
6. ensure two tubing clamps are hanging from the cart
7. ensure two 60 ml syringes are on top of cart
8. ensure all ecmo circuit connections are secure/intact and not in danger of being
compromised
9. ensure the ecmo cannulas and tubing are "off" the floor and properly secured
10. confirm the location of the back up ecmo console and insertion cart
, what do elevated peak pressures indicate? - Answer- airway issue
- bronchospasm
- secretions
- mucus plug
- ETT occlusion
what do elevated plateau pressures indicate? - Answer- compliance issues
- pneumothorax
- pulmonary edema
- ARDS
- pneumonia
what is the appropriate oxygenation for VV Ecmo? - Answer- PaO2 >50-60
SpO2 > 85-88%
what is hyperdynamic heart on VV ecmo? how do you treat it? - Answer- ecmo is
unable to capture at least 2/3 of patients native CO which will cause the SPO2 to drop
- fever control, increase flows, optimize pain/sedation, decrease native CO with
betablockers
how can you tell if recirculation is occurring? - Answer- 1. both cannulas are bright red
2. a high pre-oxygenator SO2 (75-100%) and low patient SaO2 (85%)
3. can assess with pre and post oxy gases - if they are similar= recirc is occurring
how do you fix recirculation? - Answer- -decrease flows and allow more blood to escape
the loop of recirculation
- increase blood volume or CO
- manipulate cannula position
- switch to crescent cannula
what are the steps of decannulation on VV ecmo? - Answer- 1. specialist will return
blood while phyisian is placing purse string sutures around each cannula
2. once blood is flushed back, ecmo circuit is clamped and ecmo pump is turned off
3. physican will pull cannula, tie suture, and hold pressure
4. keep patient supine for 2 to4 hrs
when is VA ecmo an option? - Answer- an option for the management of severe but
reversible causes of cardiogenic shock and/or respiratory failure
what is the formula for SVO2 - Answer- SVO2 = DO2 - VO2
what is the definition of north- south syndrome? - Answer- cardiac recovery in the
presence of respiratory compromise
how do you treat north- south syndrome? - Answer- Use R rad artline
QUESTIONS WITH ALL CORRECT
ANSWERS
What is the delta P? - Answer- transmembrane pressure Ppre- Ppost
trend- should be less than 60
if increasing, clotting occurs
What is the connection order for the CRRT? - Answer- access- closest to the pump
return- closest to the oxygenator (neg side)
What is chattering? - Answer- collapse of the vein around the venous cannula due to
hypovolemia
what is hemolysis, s/s, tx - Answer- breakdown of red blood cells
hematuria and elevated plasma free hgb
decrease RPM's, transfuse
What do six things do you take when you travel with ECMO? - Answer- 1. hand crank
2. clamps x 4
3. emergency meds
4. volume - albumin/ LR
5. back up O2 tank
6. battery fully charged
What do you do with ECMO during swan insertion? - Answer- turn down flows!!
what do you do with ecmo for echos? - Answer- decrease flow to 2 lpm
list 10 safety checks that need performed q4h - Answer- 1. verify all electrical cords are
plugged into the red outlet
2. verify wall oxygen and medical air blender is plugged into wall
3. ensure there is at least on full O2 tank available in ECMO cart
4. ensure the gas line from blender is connected to oxygenator
5. ensure the emergency hand crank is in the ECMO pump cart
6. ensure two tubing clamps are hanging from the cart
7. ensure two 60 ml syringes are on top of cart
8. ensure all ecmo circuit connections are secure/intact and not in danger of being
compromised
9. ensure the ecmo cannulas and tubing are "off" the floor and properly secured
10. confirm the location of the back up ecmo console and insertion cart
, what do elevated peak pressures indicate? - Answer- airway issue
- bronchospasm
- secretions
- mucus plug
- ETT occlusion
what do elevated plateau pressures indicate? - Answer- compliance issues
- pneumothorax
- pulmonary edema
- ARDS
- pneumonia
what is the appropriate oxygenation for VV Ecmo? - Answer- PaO2 >50-60
SpO2 > 85-88%
what is hyperdynamic heart on VV ecmo? how do you treat it? - Answer- ecmo is
unable to capture at least 2/3 of patients native CO which will cause the SPO2 to drop
- fever control, increase flows, optimize pain/sedation, decrease native CO with
betablockers
how can you tell if recirculation is occurring? - Answer- 1. both cannulas are bright red
2. a high pre-oxygenator SO2 (75-100%) and low patient SaO2 (85%)
3. can assess with pre and post oxy gases - if they are similar= recirc is occurring
how do you fix recirculation? - Answer- -decrease flows and allow more blood to escape
the loop of recirculation
- increase blood volume or CO
- manipulate cannula position
- switch to crescent cannula
what are the steps of decannulation on VV ecmo? - Answer- 1. specialist will return
blood while phyisian is placing purse string sutures around each cannula
2. once blood is flushed back, ecmo circuit is clamped and ecmo pump is turned off
3. physican will pull cannula, tie suture, and hold pressure
4. keep patient supine for 2 to4 hrs
when is VA ecmo an option? - Answer- an option for the management of severe but
reversible causes of cardiogenic shock and/or respiratory failure
what is the formula for SVO2 - Answer- SVO2 = DO2 - VO2
what is the definition of north- south syndrome? - Answer- cardiac recovery in the
presence of respiratory compromise
how do you treat north- south syndrome? - Answer- Use R rad artline
