ECMO Specialist UPDATED Actual Exam
Questions and CORRECT Answers
How to recognize cardiogenic shock? (acronym) - CORRECT ANSWER- ✔✔CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) - CORRECT ANSWER- ✔✔(ECLS )
ECG
Consult- surgeon
Labs- lactates, abgs etc.
Swan catheter
what is PAPI score? Formula and normal value - CORRECT ANSWER- ✔✔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 ANSWER-
✔✔CPO= MAP x CO/451
normal = 0.7 to 1 W
what are the three key measurements for cardiogenic shock? - CORRECT ANSWER-
✔✔PAPI
,CPO
Lactate
what is cardiac power output? - CORRECT ANSWER- ✔✔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 ANSWER- ✔✔anerobic
metabolism is occurring
normal is 0.9 to 1.7
what are the two goals of mechanical circulatory support? - CORRECT ANSWER-
✔✔restore adequate end organ perfusion
ventricular unloading
how does the impella CP work as an LV vent? - CORRECT ANSWER- ✔✔drains at LV and
returns at the aortic arch
provides 3-3.5 LPM of flow
what are the 5 factors affecting pharmacokinetics with critical illness? - CORRECT
ANSWER- ✔✔1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? - CORRECT ANSWER- ✔✔the bodys biological response to
the drug
, what are the factors 5 affecting pharmacokinetics with ECMO? - CORRECT ANSWER-
✔✔1. augmented cardiac output
2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
which drugs should you avoid with ecmo? - CORRECT ANSWER- ✔✔benzos!!! lipophillic
and sequester in the tubing
why do we need anticoagulation on ecmo? - CORRECT ANSWER- ✔✔blood contacts the
ecmo circuit causing a sirs response and leads to:
inflammation/vasodilation
coagulation
altered fibrinolysis
how does heparin work? - CORRECT ANSWER- ✔✔Activates antithrombin III ->
inactivates thrombin, factor IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? - CORRECT ANSWER- ✔✔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 ANSWER- ✔✔1.
impaired gas exchange
2. decreased compliance
3. increased pulmonary arterial pressure
what are the two things that happen with impaired gas exchange? - CORRECT ANSWER-
✔✔1. V/Q mismatch - alveolar shunting
2. increased dead space - high minute ventilation and impaired CO2 elimination
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