1.) When an ecmo circuit is requested to be on standby for a post op heart repair, that means we are on
ecmo alert level ___? - one
1-2.) Most standby circuits are used on the patient it was requested for? - false
3-6.)ecmo alert level 1 - guarded-possible-under early consideration
3-6.)ecmo alert level 2 - probable-pt status worsening-on call brought in, in house brought to bedside,
cannulas at bedside with pump and cart but no blood priming
3-6.)ecmo alert level 3 - initiation- no cpr being done. controlled go on. blood prime if needed
3-6.)ecmo alert level 4 - medical alert ecls-code blue first-cannulate stat
7.)why do most patients and particularly neonates not require ecmo? - more advances in prenatal care,
more ways to treat pphn and other defects.
8-10.) 3 main features of PPHN - 1. hypoxia, pulmonary vasoconstriction
2. pulmonary hypertension, right to left shunting
3. elevated pulmonary pressure
4. tricuspid regurgitation 5. lung disease, lung hypoplasia, mal develeopment of lungs.
11.) describe how ecmo benefits the patient with PPHN? - provides adequate oxygenation, provides rest
for the heart and lungs until patient can go to surgery or the pphn can be resolved.
12-14.) describe the pda shunt dynamics when a patient is placed on ecmo. include how this shunting
may/may not affect ecmo flows in V-A. - ecmo works as the heart, depending on the placement of
cannulas and amount of bypass. lower fio2 and sweep due to mixing of oxygen. worry about
recirculation and promoting systemic circulation.
, 12-14.) describe the pda shunt dynamics when a patient is placed on ecmo. include how this shunting
may/may not affect ecmo flows in V-V. - increase flows to perfuse body, pulmonary edema. worry about
recirculation and promote systemic circulation.
15-16.) explain the effect of PDA ligation on urinary output of a V-A ecmo patient. Are there any
differences for the V-V ecmo patients? - after PDA ligation, theres more perfusion to the body causing
perfusion to the kidneys. VV has pulsetile perfusion because the heart is still pumping (intrinsic rate) for
there is more perfusion to the kidneys which makes better urine output.
17-19.) list some features of the sano shunt - conduit from RV to PA. systemic to pulmonary shunt. can
be clipped for ecmo and unclipped when taken off ecmo
20-23.) how does ecmo benefit the patient with failure to come off cardiopulmonary bypass after cadiac
defect repair? - works as the heart while the heart recovers
20-23.) how does ecmo benefit the patient with respiratory failure? - gives lungs a break so they can
repair/recover
24.) how does the sano shunt repair affect ecmo management? - blood flows from the right ventricle to
lungs/pumonary artery. could increase flow to the lungs when on ecmo. must be unclipped when off
ecmo. Fio2 may need to be lower to prevent shunting or coronary steal.
25.) what is one of the most critical pieces of information to receive about a s/p sano shunt patient
placed on ecmo? - is the shunt clipped or unclipped
26-37.) list four contraindications to ecmo for neonates - brain bleed, less than 2kg,
genetic/chromosomal/metabolic syndrome with poor prognosis, uncontrolled bleeding, uncorrectable
CHD, inaccessible vessels, DNR, mechanical vent greater than 7 days, major immunosupression
(absolute neutrophil<400)
26-37.) list four contraindications to ecmo for pediatric - neurofunction absent, incurable disease, cns
hemmorhage, uncontrolled bleeding, extreme size/weight, inaccessible vessels, DNR, mechanical vent
greater than 7 days, major immunosupression (absolute neutrophil<400)
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