CES ECMO Complications & Management

Question 1

Harlequin syndrome (differential hypoxia) occurs in which ECMO configuration?

Accepted Answer

Peripheral VA ECMO with femoral cannulation and recovering cardiac function

Answer

VV ECMO with dual-lumen cannula

Answer

Central VA ECMO via the aorta

Answer

VV ECMO with bi-caval dual-lumen cannula

Question 2

What is the best monitoring strategy to detect Harlequin syndrome early?

Accepted Answer

Right-hand (pre-ductal) pulse oximetry combined with arterial blood gas from the right radial artery

Answer

Continuous SvO2 monitoring at the drainage cannula

Answer

Bilateral lower limb SpO2 comparison

Answer

Continuous end-tidal CO2 monitoring

Question 3

Neurological complications are most common in which ECMO patient population?

Accepted Answer

Neonates on VA ECMO

Answer

Adults on VV ECMO for ARDS

Answer

Adults on VA ECMO for post-cardiac arrest

Answer

Pediatric patients on VV ECMO

Question 4

Acute hemolysis on ECMO is best indicated by which laboratory finding?

Accepted Answer

Rising LDH and plasma-free hemoglobin > 50 mg/dL

Answer

Falling platelet count

Answer

Rising serum creatinine

Answer

Elevated direct bilirubin

Question 5

Chatter (vibration/cavitation) in the drainage tubing most commonly indicates:

Accepted Answer

Hypovolemia or high resistance at the drainage cannula causing inlet suction

Answer

Oxygenator thrombosis

Answer

Excessive circuit flow rates

Answer

Air entrainment from the venous access site

Question 6

The most common infectious complication in ECMO patients is:

Accepted Answer

Ventilator-associated pneumonia

Answer

Candida bloodstream infection

Answer

ECMO circuit-related bloodstream infection

Answer

Urinary tract infection