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

Harlequin syndrome occurs in peripheral VA ECMO when the recovering heart ejects deoxygenated blood into the aorta, competing with retrograde oxygenated ECMO flow.

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

Right radial arterial ABG and right-hand SpO2 reflect the coronary and cerebral circulation, revealing upper body hypoxia in Harlequin syndrome.

Question 3

Neurological complications are most common in which ECMO patient population?

Accepted Answer

Neonates on VA ECMO

Answer

Neonates on VA ECMO have the highest rates of neurological complications including IVH, stroke, and seizures due to their vulnerable developing brains.

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

Elevated LDH and plasma-free hemoglobin above 50 mg/dL are the hallmark laboratory indicators of significant hemolysis in ECMO circuits.

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

Drainage tubing chatter reflects excessive inlet suction, typically caused by hypovolemia, cannula malposition, or high drainage resistance.

CES - Certified ECMO Specialist Practice Test

CES - Certified ECMO Specialist Practice Test

CES ECMO Complications & Management