Mixed Deck — All CES Topics Flashcards

In VA-ECMO, increasing pump flow rate will primarily have which effect?

Answer: Decrease venous return to the native heart, reducing native cardiac preload

Higher VA-ECMO flows drain more blood from the venous side, reducing preload to the right heart and diminishing native cardiac output.

What is the primary purpose of anticoagulation during ECMO therapy?

Answer: To stop clot formation

The foreign surfaces of the ECMO circuit activate the coagulation cascade, making clot formation (thrombosis) a significant risk. Anticoagulation, typically with heparin, is administered to prevent these clots from forming within the circuit, which could lead to circuit failure, or from embolizing to the patient, causing severe complications like stroke or organ damage. This is crucial for circuit patency and patient safety.

The Avalon Elite bicaval dual-lumen cannula is designed for insertion via which access site?

Answer: Right internal jugular vein

The Avalon Elite is designed for right internal jugular vein insertion, with drainage from both the SVC and IVC and return directed toward the tricuspid valve.

What is the minimum recommended ACT range during a weaning trial to reduce thrombosis risk without excessive bleeding?

Answer: 160–180 seconds

During weaning trials, maintaining ACT between 160–180 seconds balances circuit thrombosis prevention with hemorrhagic risk.

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.

What is the primary purpose of a 'bridge connector' in an ECMO circuit?

Answer: To allow the circuit to be clamped and recirculated when the patient is briefly disconnected or during circuit changes

A bridge connector allows the circuit to recirculate when the patient limbs are clamped, maintaining circuit patency and preventing stasis/clotting during brief interventions.

After successful decannulation of a femoral arterial VA ECMO cannula, the preferred method of hemostasis is:

Answer: Figure-of-eight suture with surgical cut-down or purse-string closure

Femoral arterial decannulation typically requires surgical closure (figure-of-eight or purse-string suture) due to the large-bore cannula size.

Which contraindication to ECMO is considered RELATIVE rather than absolute?

Answer: Age > 70 years with multisystem disease

Advanced age with multisystem disease is a relative contraindication; decisions require individualized risk-benefit assessment.

Which laboratory value indicates kidney function during ECMO?

Answer: Creatinine

Creatinine is a waste product filtered by the kidneys, and its blood levels are a primary indicator of kidney function. Elevated creatinine levels suggest impaired renal clearance, which can be a common complication in critically ill ECMO patients due to factors like hypoperfusion, nephrotoxic medications, or pre-existing kidney disease. Monitoring creatinine helps assess kidney health and guide fluid and medication management.

Structured ECMO handoff communication (SBAR) should include which ECMO-specific element?

Answer: Current circuit flow, pressures, sweep gas settings, anticoagulation status, and recent alarms

ECMO-specific SBAR handoff must include flow, pressure parameters, sweep gas, anticoagulation status, and any recent alarms or interventions.

What is the purpose of having a 'crash cart' near ECMO patients?

Answer: To initiate CPR and provide emergency drugs

ECMO patients are critically ill and can rapidly decompensate, requiring immediate resuscitation. A crash cart contains essential equipment and medications for cardiopulmonary resuscitation (CPR), including defibrillators, airway management tools, and emergency drugs. Its proximity ensures rapid access to life-saving interventions during a cardiac arrest or other acute medical emergencies, optimizing patient outcomes.

Why is daily fluid balance monitoring important in ECMO therapy?

Answer: To prevent fluid overload

Critically ill ECMO patients are prone to fluid retention due to systemic inflammation, capillary leak, and impaired renal function. Meticulous daily fluid balance monitoring is essential to prevent fluid overload, which can lead to pulmonary edema, impaired oxygenation, increased cardiac workload, and other complications. Maintaining euvolemia is crucial for optimal outcomes and preventing secondary organ dysfunction.

What is the best monitoring strategy to detect Harlequin syndrome early?

Answer: Right-hand (pre-ductal) pulse oximetry combined with arterial blood gas from the right radial artery

Right radial arterial ABG and right-hand SpO2 reflect the coronary and cerebral circulation, revealing upper body hypoxia in Harlequin syndrome.

What is the most effective way to reduce recirculation in a bicaval dual-lumen VV ECMO cannula?

Answer: Repositioning the cannula so the return port faces the tricuspid valve

Correct positioning of the dual-lumen cannula with the return port (Avalon/ProtekDuo) directed toward the tricuspid valve minimizes recirculation.

What does the term 'sweep gas' refer to in an ECMO oxygenator?

Answer: The gas (oxygen/air blend) flowing through the oxygenator membrane to facilitate gas exchange

Sweep gas is the gas flow (typically an O2/CO2 blend) through the hollow-fiber membrane oxygenator that drives CO2 removal and sets membrane-side gas composition.

Which condition is a primary indication for veno-venous (VV) ECMO?

Answer: Severe refractory respiratory failure

VV ECMO is indicated for severe refractory respiratory failure when conventional ventilatory support is insufficient.

Which surgical technique is used for decannulation when the femoral artery requires patch repair?

Answer: Vein patch angioplasty or synthetic patch closure to prevent stenosis

When primary closure would narrow the femoral artery, vein patch angioplasty or a synthetic patch is used to maintain vessel patency.

Acute hemolysis on ECMO is best indicated by which laboratory finding?

Answer: Rising LDH and plasma-free hemoglobin > 50 mg/dL

Elevated LDH and plasma-free hemoglobin above 50 mg/dL are the hallmark laboratory indicators of significant hemolysis in ECMO circuits.

Who has primary responsibility for ECMO circuit management during a patient transport?

Answer: The ECMO specialist (perfusionist or trained clinician) accompanying the patient

The ECMO specialist is responsible for circuit management, troubleshooting, and safety during patient transport.

During a VV ECMO weaning trial, sweep gas flow is typically reduced to assess:

Answer: Native lung's ability to maintain gas exchange independently

Reducing sweep gas (CO2 removal drive) while monitoring SpO2 and PaCO2 tests whether the native lungs can sustain adequate gas exchange.