Mechanical Circulatory Support & ECMO Management Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Mechanical Circulatory Support & ECMO Management flashcards as text
When should the perfusionist consider adding left ventricular venting during VA-ECMO?
Answer: When left ventricular distension occurs because the native heart cannot eject against the increased afterload
LV venting decompresses the distended ventricle that cannot eject against the retrograde afterload imposed by VA-ECMO, reducing wall stress and myocardial oxygen demand to promote recovery.
What does an increasing transmembrane pressure difference (delta P) across the ECMO oxygenator indicate?
Answer: Progressive clot formation or membrane fouling within the oxygenator
A rising delta P (pressure gradient across the oxygenator) indicates increasing resistance due to thrombus or fibrin deposition within the device, signaling impending oxygenator failure.
Which laboratory marker is used to detect hemolysis in ECMO patients?
Answer: Plasma free hemoglobin
Plasma free hemoglobin is the direct indicator of hemolysis; elevated levels confirm that red blood cells are being mechanically destroyed within the ECMO circuit.
What is the most common cause of circuit-induced hemolysis during ECMO support?
Answer: High negative suction pressure at the venous cannula causing cavitation
Excessive negative pressure at the venous drainage cannula causes cavitation and direct mechanical shear stress on red blood cells, leading to hemolysis.
After LVAD implantation, which parameter set is most critical to monitor for right heart failure?
Answer: Central venous pressure (CVP) and pulmonary artery pressures
The LVAD dramatically increases left heart output, raising pulmonary venous return; the right ventricle must handle this increased load, and rising CVP with elevated PA pressures signals RV failure.
What cannulation sites are used for central (as opposed to peripheral) VA-ECMO?
Answer: Right atrium to ascending aorta
Central VA-ECMO uses a right atrial venous drainage cannula and an ascending aortic arterial return cannula, mirroring standard cardiopulmonary bypass cannulation performed in the operative field.
Which ECMO configuration provides simultaneous cardiac output support AND correction of hypoxemia?
Answer: Veno-arterial (VA) ECMO
VA-ECMO drains deoxygenated venous blood, oxygenates it through the membrane lung, and returns it to the arterial circulation, thereby supporting both cardiac output and systemic oxygenation simultaneously.