ECMO Complications & Management Flashcards

Retroperitoneal hematoma during ECMO is most often related to:

Answer: Over-anticoagulation combined with femoral cannulation

Retroperitoneal hematoma frequently results from a combination of anticoagulation and femoral access, especially if the access wire or cannula traverses the posterior peritoneum.

Oxygenator thrombosis is first suspected when:

Answer: Transmembrane pressure gradient across the oxygenator acutely rises

A rising transmembrane pressure gradient (pre- vs. post-oxygenator pressure difference) indicates increasing resistance from thrombus formation within the oxygenator.

Which anticoagulation monitoring approach is recommended when heparin-induced thrombocytopenia (HIT) is suspected on ECMO?

Answer: Discontinue heparin and transition to bivalirudin, monitoring aPTT or ACT

Bivalirudin is the preferred anticoagulant when HIT is suspected or confirmed during ECMO, monitored via aPTT or ACT.

Massive air embolism in the ECMO circuit requires immediate:

Answer: Clamping the circuit and placing the patient in Trendelenburg position

Clamping the circuit to prevent air delivery to the patient plus Trendelenburg positioning to trap air in the right side is the immediate response to massive air embolism.

Left ventricular distension during VA ECMO is caused by:

Answer: Increased left ventricular afterload from retrograde aortic flow combined with poor LV ejection

Retrograde VA ECMO flow increases LV afterload; if the LV cannot eject against this pressure, the ventricle distends, worsening myocardial recovery.

Which intervention is used to vent the distended left ventricle during VA ECMO?

Answer: Intra-aortic balloon pump (IABP) or Impella device to offload the LV

An IABP or Impella device provides mechanical left ventricular unloading, reducing wall stress and enabling myocardial recovery during VA ECMO.