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ECMO study questions with correct answers.
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ECMO study questions with correct answers.
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ECMO study questions with correct answers.What are 3 factors that affect oxygen delivery? Answer - - Hemoglobin
- Cardiac Output / ECMO flow
- Oxygen saturation
Key term for VA-ECMO? Answer - Partial bypass
Key term for VV-ECMO? Answer - Partial capture
On which type of ECMO do you run a full code (with compression)? Answer - VV-
ECMO
Which ECMO requires full drugs per ACLS but no compressions in a code? Answer -
VA-ECMO
mL in an ECMO circuit? Answer - 800mL
mL in an ECMO circuit + CVVHD? Answer - 1100mL
In which type of ECMO is SvO2 utilized? Answer - VA-ECMO
What are the "3 C's" in an ECMO emergency? Answer - - Clamp
- Call for help
- Compensate for losses in support with drugs and other measures
What is the default anticoagulant used in ECLS? Answer - Heparin
What are the actions of heparin? Answer - - Accelerates the action of endogenous antithrombin.
- Inhibits thrombin and factor Xa
What is the normal dose of heparin given at the time of ECMO cannulation? Answer - 50 - 100 units / kg
What blood product is indicated for patients who are heparin resistant 2/2 diminshed antithrombin levels? Answer - FFP
What is the standard goal aPTT for ECMO patients being heparinized? Answer - 50 -
75
Clotting that occurs when blood comes into contact with a non-endothelial surface Answer - Intrinsic pathway Clotting that occurs by the release of tissue factor from damaged tissue Answer - Extrinsic pathway
Current survivial rate of patients put on ECMO for cardiac reasons? Answer - 23 - 71%
What are some contraindications to ECMO? Answer - - End-stage, irreversible, or inoperable cardiac disease.
- Significant neurological or end-stage renal impairment.
- Uncontrolled bleeding of major organs. - Extremes of size or weight (relative)
- Inaccessible vessels during CPR (though femoral is usually accessible)
Placement options for venous drainage of VV-ECMO? Answer - - Femoral Vein
- R IJ (if an Avalon Cannula)
Both drain venous blood from the SVC
Placement options for return blood of VV-ECMO? Answer - - Right IJ
- Right Axillary vein
- Right Subclavian vein
All terminate in the RA with the outflow directed at the Tricuspid valve.
What percentage of cardiac output is provided by VV-ECMO? Answer - 0%
What percentage of cardiac output can be provided by VA-ECMO? Answer - 60 - 80%
Cannulation sites for venous drainage in VA-ECMO? Answer - - Femoral vein
- Right IJ
Both terminate in the SVC
Cannulation sites for arterial (return) cannula? Answer - - Femoral artery
- Axillary artery
- Carotid artery
- Transthoracic (direct) cannulation
When "resting the lungs" with VV-ECMO, what are common ventilator settings? Answer - RR <10 (We will allow permissive hypercapnea while resting)
Long inspiratory times (i:e)
Low inspiratory pressures (< 25 cmH2O)
Low Tidal Volumes
Standard PEEP (high PEEP can inhibit venous return)
Low FiO2 (<30%)
Indications for VV-ECMO Answer - Severe pneumonia
Flu
Asthma
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