CES ECMO Complications & Management 2

Question 1

Retroperitoneal hematoma during ECMO is most often related to:

Accepted Answer

Over-anticoagulation combined with femoral cannulation

Answer

Retroperitoneal hematoma frequently results from a combination of anticoagulation and femoral access, especially if the access wire or cannula traverses the posterior peritoneum.

Question 2

Oxygenator thrombosis is first suspected when:

Accepted Answer

Transmembrane pressure gradient across the oxygenator acutely rises

Answer

A rising transmembrane pressure gradient (pre- vs. post-oxygenator pressure difference) indicates increasing resistance from thrombus formation within the oxygenator.

Question 3

Which anticoagulation monitoring approach is recommended when heparin-induced thrombocytopenia (HIT) is suspected on ECMO?

Accepted Answer

Discontinue heparin and transition to bivalirudin, monitoring aPTT or ACT

Answer

Bivalirudin is the preferred anticoagulant when HIT is suspected or confirmed during ECMO, monitored via aPTT or ACT.

Question 4

Massive air embolism in the ECMO circuit requires immediate:

Accepted Answer

Clamping the circuit and placing the patient in Trendelenburg position

Answer

Clamping the circuit to prevent air delivery to the patient plus Trendelenburg positioning to trap air in the right side is the immediate response to massive air embolism.

Question 5

Left ventricular distension during VA ECMO is caused by:

Accepted Answer

Increased left ventricular afterload from retrograde aortic flow combined with poor LV ejection

Answer

Retrograde VA ECMO flow increases LV afterload; if the LV cannot eject against this pressure, the ventricle distends, worsening myocardial recovery.

CES - Certified ECMO Specialist Practice Test

CES - Certified ECMO Specialist Practice Test

CES ECMO Complications & Management 2