Question 1

It is not uncommon for patients undergoing ECMO to experience renal failure.What can be done to enhance renal function?&#10;A)Add either colloids or crystalloids to fluid challenge the patient.&#10;B)Perform hemofiltration.&#10;C)Add either vasodilators or vasoconstrictors.&#10;D)Conduct plasmapheresis.

Accepted Answer

It is not uncommon for patients requiring ECMO to develop renal insufficiency from pre-ECMO fluid resuscitation,acute renal dysfunction,and blood product replacement.To augment renal function and remove larger quantities of fluid,a semipermeable membrane or hemofilter can be added to the ECMO circuit.

Question 2

Because the minimum flow rate required to remove condensation in the gas compartment usually results in excessive elimination of carbon dioxide,what should the therapist do?&#10;A)Reduce pump flow&#10;B)Blend sweep gas with a carbogen mixture&#10;C)Reduce the amount of oxygen blended in the sweep gas&#10;D)Add more oxygen to the sweep gas

Accepted Answer

Because the minimum flow rate required to remove condensation usually results in excessive elimination of carbon dioxide,sweep gas is often blended with a carbogen mixture,which reduces the driving pressure across the membrane and maintains normocarbia.

Question 3

What is the advantage of having the centrifugal pump automatically respond to resistances against which it is pumping?&#10;A)It avoids placing increased pressures on the heart.&#10;B)It eliminates lowering pulmonary vascular pressures.&#10;C)It maintains regulated flow through the system.&#10;D)It ensures that the blood flows smoothly through the membrane oxygenator.

Accepted Answer

Centrifugal pumps are nonocclusive devices because energy is transferred to the blood by a rapidly rotating cone-shaped pump head that creates a constrained vortex.Blood is actively pulled inward and propelled outward by the energy created by the vortex,thus drainage is considered active.Because this type of pump is nonocclusive is it dependent on the patient's preload and afterload.As preload decreases,such as decreased venous drainage,or if afterload increases due to increased systemic vascular resistance,flow will decrease.

Question 4

Which of the following mechanisms affect the output of VV ECMO?
I)Size of the tubing
II)The rotations per minute
III)Tension of the rollers
IV)Blood pressure

A)I.II,and III only
B)I and IV only
C)II,III,and IV only
D)I,II,III,and IV

Accepted Answer

The output depends on the size of the tubing,the rotations per minute (RPMs),and the tension or occlusion of the rollers on the raceway.

Question 5

What are the major advantages of venovenous ECMO?&#10;A)Pulsatile flow in maintained.&#10;B)Cardiovascular support is uninvolved.&#10;C)It is less expensive than VA ECMO.&#10;D)The internal jugular vein is not cannulated twice.

Accepted Answer

One advantage of VV support is that carotid artery ligation is not required,full pulsatile native blood flow is maintained,and the potential for air or particulate emboli from the circuit is less.A disadvantage is the lack of cardiovascular support.However,the presence of mild to moderate myocardial dysfunction should not discourage the use of the VV approach because the improved oxygenation and lower airway pressures achieved with implementation of VV ECMO often improve cardiac function.

Question 6

A neonate on mechanical ventilation with respiratory distress has a PaO? of 50 mm Hg,a $\overline{ { Paw }}$ of 20 cm H?O and FiO? of 0.8.Why should the therapist suggest therapies other than ECMO?

A)The Fio? is not 100% yet.
B)The

\overline{ { Paw }}

is not high enough to justify ECMO.
C)The OI does not meet ECMO criteria.
D)The PaO? is within normal limits.

Accepted Answer

The Oxygenation Index (OI) is used to assess the severity of respiratory failure and determine ECMO eligibility. An OI of 40 or more typically indicates ECMO consideration. The given values do not suggest an OI high enough to meet ECMO criteria.

Question 7

Which of the following statements describes venoarterial ECMO?&#10;A)A cannula is inserted into the subclavian vein for the removal of blood.&#10;B)Blood is removed from the venous circulation through the external jugular vein.&#10;C)Blood returns to the heart through the subclavian artery.&#10;D)A cannula is inserted into the right common carotid artery for arterial return.

Accepted Answer

ECMO support begins by accessing the vasculature in order to establish drainage and reinfusion sites.In newborns and infants,perfusion cannulas are surgically placed in a vein,commonly the right-internal jugular,and an artery,usually the right common carotid.This is the classic venoarterial (VA)configuration in which deoxygenated venous blood is drained from the patient and blood that is fully saturated with oxygen is artificially pumped and returned to the arterial system (refer to Figure 19-1A in the textbook).

Question 8

Which of the following conditions are considered contraindications for neonatal ECMO?&#10;A)Meconium aspiration&#10;B)Less than 2 kg of weight&#10;C)Prolonged mechanical ventilation (7 to 10 days)&#10;D)Less than 36 weeks of gestation

Accepted Answer

Typically the need for ECMO is identified within the first couple of days.The need for ECMO following a prolonged period of mechanical ventilation,such as 7 to 10 days,suggests atypical lung pathology that may not be reversible.Another consideration for deciding not to use ECMO is the patient's size and gestational age.There are ECMO catheter size limitations for newborns less than 2 kg,and newborns less than 32 weeks gestation may be at greater risk for developing intracranial hemorrhage when exposed to anticoagulants.

Question 9

Which of the following conditions are cardiac applications of ECMO?
I)ECPR
II)CDH
III)Fulminant myocarditis
IV)Cardiomyopathy

A)I and II only
B)III and IV only
C)I,III,and IV only
D)I,II,III,and IV

Accepted Answer

The availability of ECMO is an important facet in the medical-surgical management of congenital heart disease (CHD).In the preoperative period,ECMO is used to augment cardiac output and support organ function until palliative or corrective surgery is undertaken.ECMO is also used in the postoperative period,particularly in complex CHD,as more challenging surgical repairs are attempted.ECMO has also been used during interventional procedures.Patients with cardiac muscle disease,such as fulminant myocarditis or cardiomyopathy,may have such poor heart function that the need for mechanical support with ECMO is necessary.Although other mechanical circulatory support devices would provide equivalent support,ECMO systems are more readily available and can be implemented in the ICU.When cardiac function fails to recover,ECMO becomes a key support device while heart transplantation options or other support devices are considered.The use of ECMO for cardiac support continues to grow,particularly as an aid to resuscitation,or ECMO during cardiopulmonary resuscitation,referred to as ECPR.

Question 10

The therapist in charge of a patient on ECMO is monitoring ACT every 30 minutes.The last ACT was 100 seconds.What should the therapist suggest at this time?&#10;A)Decrease the amount of platelets transfused.&#10;B)Increase the heparin dose.&#10;C)Add plasminogen.&#10;D)Increase blood flow to decrease contact time.

Accepted Answer

The classic method for monitoring anticoagulation is to measure the activated clotting time (ACT)with a point-of-care device.The heparin dose is titrated to achieve an ACT range of typically 160 to 180 seconds.

Question 11

What are the most common causes of a decrease in venous return in ECMO?
I)Hypovolemic state
II)Malpositioning of the venous cannula
III)Kinking of the cannula
IV)Shifting of the mediastinum

A)I and III only
B)II and III only
C)I,II,and III only
D)I,II,III,and IV

Accepted Answer

The answer of What are the most common causes of...

Question 12

During administration of venovenous ECMO,the therapist notices that the SvO&#8322; is greater than SaO&#8322;.What is the best explanation to this phenomenon?&#10;A)The blood flow through the pump is too slow.&#10;B)Recirculation is excessive.&#10;C)Native cardiac output has increased.&#10;D)iNO is being administered concomitantly.

Accepted Answer

The answer of During administration of venovenous ECMO,the therapist notices...

Question 13

Which of the following parameters have been suggested as indications for pediatric ECMO?
I)PaO₂ < 50 mm Hg
II)PaO₂/FiO₂ < 75
III)OI > 35
IV)Pre-ECMO pH < 7.20

A)II,III and IV only
B)I,II,and III only
C)I,II,and IV only
D)II and IV only

Accepted Answer

The answer of Which of the following parameters have been...

Question 14

In the gas membrane exchanger,what is one of the limiting factors to the transfer rate of oxygen across the membrane?&#10;A)The flow of blood&#10;B)The concentration gradient of the gas across the membrane&#10;C)The thickness of the blood film between the membrane layers&#10;D)The flow of gas in relationship to the flow of blood

Accepted Answer

The answer of In the gas membrane exchanger,what is one...

Question 15

The ECMO specialist has noticed excessive clotting in the circuit despite increase doses of heparin.What is the most feasible explanation for this event?&#10;A)Too many platelet transfusions&#10;B)Defective heparin&#10;C)Blood flow too slow&#10;D)Deficiency of ATIII

Accepted Answer

The answer of The ECMO specialist has noticed excessive clotting...

Question 16

What is the key reason for making ECMO so successful in newborns?&#10;A)Newborns do not have as a high risk for bleeding as other age groups.&#10;B)Newborns require less ECMO flows.&#10;C)Newborns have fewer side effects when treated with heparin drips.&#10;D)Most clinical conditions treated with ECMO in newborns are reversible.

Accepted Answer

The answer of What is the key reason for making...

Question 17

During venovenous ECMO,what effect does the cardiac output have on oxygenation?&#10;A)An increase in cardiac output will have a significant effect on the patient's oxygenation.&#10;B)A decrease in cardiac output will have a major impact on the patient's oxygenation.&#10;C)Changes in cardiac output either way will have little influence on the patient's oxygenation.&#10;D)The influence of alterations in cardiac output on the patient's oxygenation cannot be predicted.

Accepted Answer

The answer of During venovenous ECMO,what effect does the cardiac...

Question 18

Which of the following strategies is greatly responsible for decreasing the need for ECMO in neonates?&#10;A)High-flow oxygen therapy&#10;B)Airway pressure release ventilation&#10;C)Heliox&#10;D)HFOV

Accepted Answer

The answer of Which of the following strategies is greatly...

Question 19

The therapist should evaluate raceway occlusion because too much roller tension could be associated with which of the following events?&#10;A)Inadequate flow&#10;B)Increased bladder tension&#10;C)Hemolysis&#10;D)Recirculation

Accepted Answer

The answer of The therapist should evaluate raceway occlusion because...

Question 20

Which of the following groups of patients has the best overall survival when treated with ECMO?&#10;A)Neonates with respiratory support&#10;B)Pediatric patients with cardiac support&#10;C)Neonates with cardiac support&#10;D)Pediatric patients with respiratory support

Accepted Answer

The answer of Which of the following groups of patients...

Question 21

Which of the following ventilator settings are typically used in ECMO for respiratory support?
I)Vt 5-7 ml/kg
II)PIP 25-25 cm H₂O
III)PEEP 2-3 cm H₂O
IV)Frequency 10-12

A)I and III only
B)II and III only
C)I,II,and IV only
D)I,II,III,and IV

Accepted Answer

The answer of Which of the following ventilator settings are...

Question 22

The therapist in charge of a patient on ECMO has noticed an increase in premembrane pressures.What is the most probable explanation?&#10;A)Very high pump flow&#10;B)Clotting in the circuit&#10;C)Damage of the raceway&#10;D)Excessive sweep flow

Accepted Answer

The answer of The therapist in charge of a patient...

Question 23

What is the ECMO flow considered as minimal support?&#10;A)100 mL/Kg&#10;B)80 ml/kg&#10;C)50 mL/Kg&#10;D)30 mL/Kg

Accepted Answer

The answer of What is the ECMO flow considered as...

Question 24

How can membrane malfunction be suspected?&#10;A)Narrowing of the premembrane and postmembrane PaCO&#8322;&#10;B)Widening of the premembrane and postmembrane PaO&#8322;&#10;C)Presence of large clots in the circuit&#10;D)Presence of air bubbles

Accepted Answer

The answer of How can membrane malfunction be suspected?&#10;A)Narrowing of...

Question 25

What is considered the most concerning complication of ECMO in the newborn?&#10;A)Disseminated intravascular coagulopathy&#10;B)Pneumonia&#10;C)Intracranial hemorrhage&#10;D)Hemosiderosis

Accepted Answer

The answer of What is considered the most concerning complication...

Deck 19: Extracorporeal Life Support