CES ECMO Indications & Patient Selection 1 — Questions and Answers
Question 1: Which condition is a primary indication for veno-venous (VV) ECMO?
- Severe refractory respiratory failure (Correct answer)
- Cardiogenic shock with preserved lung function
- Post-cardiac arrest with ROSC
- Pulmonary embolism with hemodynamic instability
Correct answer: Severe refractory respiratory failure
VV ECMO is indicated for severe refractory respiratory failure when conventional ventilatory support is insufficient.
Question 2: Veno-arterial (VA) ECMO is most appropriate for which patient presentation?
- Acute respiratory distress syndrome (ARDS)
- Refractory cardiogenic shock (Correct answer)
- Hypoxic respiratory failure alone
- Pulmonary hypertension without cardiac failure
Correct answer: Refractory cardiogenic shock
VA ECMO provides both cardiac and pulmonary support, making it the choice for refractory cardiogenic shock.
Question 3: Which Murray Score threshold typically supports consideration of ECMO for ARDS?
- ≥ 1.0
- ≥ 2.0
- ≥ 3.0 (Correct answer)
- ≥ 4.0
Correct answer: ≥ 3.0
A Murray Score ≥ 3.0 indicates severe lung injury and is a commonly used threshold for ECMO consideration.
Question 4: What is the RESP score used for in ECMO patient selection?
- Predicting survival in VA ECMO patients
- Predicting in-hospital survival for VV ECMO in respiratory failure (Correct answer)
- Assessing anticoagulation risk
- Determining cannulation site preference
Correct answer: Predicting in-hospital survival for VV ECMO in respiratory failure
The RESP (Respiratory ECMO Survival Prediction) score predicts in-hospital survival for adult patients receiving VV ECMO.
Question 5: Which of the following is generally considered a contraindication to ECMO initiation?
- PaO2/FiO2 ratio < 80 mmHg
- Unrecoverable end-organ failure without transplant plan (Correct answer)
- Age > 50 years
- Mechanical ventilation for 5 days
Correct answer: Unrecoverable end-organ failure without transplant plan
Unrecoverable end-organ failure without a bridge-to-transplant plan is a recognized contraindication because ECMO cannot offer meaningful benefit.
Question 6: Which ELSO guideline criterion for VA ECMO includes a cardiac index below what threshold?
- < 1.2 L/min/m²
- < 1.8 L/min/m² (Correct answer)
- < 2.2 L/min/m²
- < 2.5 L/min/m²
Correct answer: < 1.8 L/min/m²
ELSO guidelines suggest VA ECMO consideration when cardiac index falls below 1.8 L/min/m² despite maximal medical support.
CES ECMO Indications & Patient Selection 1
Which condition is a primary indication for veno-venous (VV) ECMO?