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

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.

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

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.

Question 3

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

Accepted Answer

Plasma free hemoglobin

Answer

Plasma free hemoglobin is the direct indicator of hemolysis; elevated levels confirm that red blood cells are being mechanically destroyed within the ECMO circuit.

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

Excessive negative pressure at the venous drainage cannula causes cavitation and direct mechanical shear stress on red blood cells, leading to hemolysis.

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

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.

(CCP) Certified Clinical Perfusionist Practice Test

(CCP) Certified Clinical Perfusionist Practice Test

CCP Mechanical Circulatory Support & ECMO Management 3