CCP Mechanical Circulatory Support & ECMO Management 2

Question 1

The intraaortic balloon pump (IABP) improves coronary artery perfusion through which mechanism?

Accepted Answer

Inflating during diastole to increase diastolic aortic pressure

Answer

Inflating during systole to augment stroke volume

Answer

Deflating during diastole to reduce venous return

Answer

Deflating during systole to decrease left ventricular preload

Question 2

What is the standard first-line anticoagulant used during ECMO support?

Accepted Answer

Unfractionated heparin

Answer

Warfarin

Answer

Bivalirudin

Answer

Fondaparinux

Question 3

A patient on peripheral VA-ECMO develops 'Harlequin syndrome.' What pathophysiology does this describe?

Accepted Answer

Upper body hypoxia when poorly oxygenated native cardiac output mixes with ECMO-oxygenated return before reaching the cerebral circulation

Answer

Lower extremity ischemia from femoral arterial cannulation

Answer

Cerebral hyperperfusion caused by excessive ECMO flow rates

Answer

Differential cyanosis between upper extremities due to subclavian steal

Question 4

Which parameter best reflects the adequacy of systemic oxygen delivery during ECMO support?

Accepted Answer

Mixed venous oxygen saturation (SvO2)

Answer

Peripheral oxygen saturation (SpO2)

Answer

End-tidal CO2 (EtCO2)

Answer

Pulmonary capillary wedge pressure (PCWP)

Question 5

What is the typical ECMO circuit flow rate range required to provide adequate cardiac output support in an adult on VA-ECMO?

Accepted Answer

2.5–4.5 L/min

Answer

0.5–1.0 L/min

Answer

1.0–2.0 L/min

Answer

6.0–8.0 L/min

Question 6

Which condition is a contraindication to intraaortic balloon pump (IABP) insertion?

Accepted Answer

Moderate aortic regurgitation

Answer

Cardiogenic shock post-myocardial infarction

Answer

Refractory unstable angina

Answer

Post-CABG low cardiac output syndrome

Question 7

In ECMO circuit management, what is the primary function of the sweep gas flowing through the oxygenator?

Accepted Answer

To remove carbon dioxide from the blood

Answer

To regulate circuit blood temperature

Answer

To maintain circuit prime volume

Answer

To prevent fibrin deposition on the membrane