CCP Mechanical Circulatory Support & ECMO Management 3

Question 1

When should the perfusionist consider adding left ventricular venting during VA-ECMO?

Accepted Answer

When left ventricular distension occurs because the native heart cannot eject against the increased afterload

Answer

When ECMO flow exceeds 4.5 L/min for more than one hour

Answer

When arterial blood pH falls below 7.20 despite bicarbonate therapy

Answer

When circuit transmembrane pressure exceeds 300 mmHg

Question 2

What does an increasing transmembrane pressure difference (delta P) across the ECMO oxygenator indicate?

Accepted Answer

Progressive clot formation or membrane fouling within the oxygenator

Answer

Improved gas transfer efficiency

Answer

Adequate anticoagulation with therapeutic ACT

Answer

Need to increase sweep gas flow rate

Question 3

Which laboratory marker is used to detect hemolysis in ECMO patients?

Accepted Answer

Plasma free hemoglobin

Answer

Serum creatinine

Answer

Platelet count

Answer

Fibrinogen level

Question 4

What is the most common cause of circuit-induced hemolysis during ECMO support?

Accepted Answer

High negative suction pressure at the venous cannula causing cavitation

Answer

Supratherapeutic anticoagulation levels

Answer

Hypothermia reducing red cell membrane flexibility

Answer

Insufficient sweep gas causing elevated PaCO2

Question 5

After LVAD implantation, which parameter set is most critical to monitor for right heart failure?

Accepted Answer

Central venous pressure (CVP) and pulmonary artery pressures

Answer

LVAD flow rate and device speed (RPM) alone

Answer

Systemic vascular resistance and mean arterial pressure

Answer

Left atrial pressure and pulmonary capillary wedge pressure only

Question 6

What cannulation sites are used for central (as opposed to peripheral) VA-ECMO?

Accepted Answer

Right atrium to ascending aorta

Answer

Femoral vein to femoral artery

Answer

Internal jugular vein to femoral artery

Answer

Right atrium to pulmonary artery

Question 7

Which ECMO configuration provides simultaneous cardiac output support AND correction of hypoxemia?

Accepted Answer

Veno-arterial (VA) ECMO

Answer

Veno-venous (VV) ECMO

Answer

Arterio-venous (AV) ECMO

Answer

Veno-pulmonary artery ECMO