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ECMO Specialist Exam Questions and Answers New Version with complete solution
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ECMO Specialist Exam Questions and Answers New Version with complete solution
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ECMO Specialist Exam1.How to recognize cardiogenic shock? (acronym): CS-
MODE Cardiac Rhythm
SBP <90
Markers- cardiac Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
2.How to diagnose shock ( acronym): (ECLS
) ECG
Consult- surgeon
Labs- lactates, abgs etc. Swan catheter
3.what is PAPI score? Formula and normal value: 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
4.Formula for cardiac power output (CPO) and normal value: CPO= MAP x CO/451
normal = 0.7 to 1 W
5.what are the three key measurements for cardiogenic shock?: PAPI CPO
Lactate
6.what is cardiac power output?: amount of energy available to maintain the perfusion of the vital organs in shock
7.what does lactate in the blood mean and normal value?: anerobic metabolism is occurring
normal is 0.9 to 1.7 .what are the two goals of mechanical circulatory support?: restore adequate end organ perfusion
ventricular unloading
9.how does the impella CP work as an LV vent?: drains at LV and returns at the aortic arch provides 3-3.5 LPM of flow
10.what are the 5 factors affecting pharmacokinetics with critical illness?: 1. augmented cardiac output
2.leaky capillaries
3.volume resusitation
4.end-organ perfusion
5.altered protein binding
11.what is pharmacodynamics?: the bodys biological response to the drug
12.what are the factors 5 affecting pharmacokinetics with ECMO?: 1. augment- ed cardiac output
2.leaky capillaries
3.end-organ perfusion
4.hemodilution
5.drug sequestration
13.which drugs should you avoid with ecmo?: benzos!!! lipophillic and sequester in the tubing
14.why do we need anticoagulation on ecmo?: blood contacts the ecmo circuit causing a sirs response and leads to:
inflammation/
vasodilation coagulation
altered fibrinolysis
15.how does heparin work?: Activates antithrombin III -> inactivates thrombin, factor IXa, & factor Xa.
16.what are the 3 definitions of ards and how are they defined?: 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
17. what are the 3 consequences of lung injury with ards?: 1. impaired gas exchange
2.decreased compliance
3.increased pulmonary arterial pressure
18. what are the two things that happen with impaired gas exchange?: 1. V/Q mismatch - alveolar shunting
2. increased dead space - high minute ventilation and impaired CO2 elimination
19.what is the hallmark sign of ards?: decreased lung compliance -- due to stiff and poorly or non-aerated lungs
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