CES ECMO Complications & Management 3

Question 1

Recirculation in a VV ECMO circuit results in:

Accepted Answer

Decreased effective oxygen delivery despite high circuit flow because oxygenated blood is re-drained before reaching the patient

Answer

Recirculation occurs when oxygenated blood from the return cannula is immediately re-drained, reducing the fraction of oxygenated blood actually delivered to the patient.

Question 2

What is the most effective way to reduce recirculation in a bicaval dual-lumen VV ECMO cannula?

Accepted Answer

Repositioning the cannula so the return port faces the tricuspid valve

Answer

Correct positioning of the dual-lumen cannula with the return port (Avalon/ProtekDuo) directed toward the tricuspid valve minimizes recirculation.

Question 3

Hypertension (systemic) is a common complication in neonatal ECMO and is best managed by:

Accepted Answer

Antihypertensive therapy to prevent intracranial hemorrhage

Answer

Systemic hypertension in neonates on ECMO significantly increases the risk of intracranial hemorrhage and must be treated with antihypertensive agents.

Question 4

A sudden drop in ECMO flow with high circuit pressures and visible dark, sluggish blood most likely indicates:

Accepted Answer

Massive circuit thrombosis

Answer

Dark sluggish blood with rising pressures and dropping flow indicates widespread circuit thrombosis, requiring emergency circuit change-out.

Question 5

Thrombocytopenia on ECMO is caused by all of the following EXCEPT:

Accepted Answer

Increased thrombopoietin production causing sequestration

Answer

Thrombocytopenia on ECMO is caused by consumption, HIT, and hemodilution — thrombopoietin actually promotes platelet production rather than causing sequestration.

CES - Certified ECMO Specialist Practice Test

CES - Certified ECMO Specialist Practice Test

CES ECMO Complications & Management 3