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

The IABP inflates at the onset of diastole, raising diastolic aortic pressure and thereby increasing coronary perfusion pressure, since coronary filling primarily occurs during diastole.

Question 2

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

Accepted Answer

Unfractionated heparin

Answer

Unfractionated heparin is the preferred anticoagulant for ECMO because it can be rapidly titrated, monitored with ACT or aPTT, and reversed with protamine if needed.

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

Harlequin (north-south) syndrome occurs when a recovering native heart ejects deoxygenated blood that perfuses the upper body before retrograde femoral ECMO-oxygenated blood can reach it, causing upper body hypoxia.

Question 4

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

Accepted Answer

Mixed venous oxygen saturation (SvO2)

Answer

Mixed venous oxygen saturation reflects the balance between oxygen delivery and tissue consumption; a declining SvO2 indicates that tissues are extracting more oxygen because delivery is insufficient.

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

Adult VA-ECMO typically targets flows of 2.5–4.5 L/min to approximate normal resting cardiac output and maintain adequate systemic perfusion.

(CCP) Certified Clinical Perfusionist Practice Test

(CCP) Certified Clinical Perfusionist Practice Test

CCP Mechanical Circulatory Support & ECMO Management 2