CES ECMO Team Roles & Communication 2 — Questions and Answers
Question 1: What is the minimum recommended ECMO specialist-to-patient ratio during active ECMO support?
- 1 specialist per 4 patients
- 1 specialist per 2 patients
- 1 dedicated specialist per ECMO patient (Correct answer)
- 1 specialist on call for the entire ICU
Correct answer: 1 dedicated specialist per ECMO patient
ELSO guidelines recommend a 1:1 dedicated ECMO specialist-to-patient ratio during active ECMO support to allow immediate response to circuit emergencies.
Question 2: When should a bedside ECMO nurse escalate to the ECMO specialist without waiting for the physician?
- When the patient's temperature drops below 37°C
- When an unresolved circuit alarm persists or circuit integrity is compromised (Correct answer)
- When the patient requests additional pain medication
- When a scheduled lab result is delayed
Correct answer: When an unresolved circuit alarm persists or circuit integrity is compromised
Unresolved circuit alarms or compromised circuit integrity require immediate ECMO specialist response, as delays can be catastrophic.
Question 3: ECMO simulation training is most valuable for team performance because it:
- Reduces the need for ECMO credentialing
- Allows teams to practice rare but high-stakes scenarios without patient risk (Correct answer)
- Replaces direct bedside ECMO experience
- Eliminates the need for ELSO guidelines review
Correct answer: Allows teams to practice rare but high-stakes scenarios without patient risk
Simulation allows ECMO teams to rehearse rare emergencies (circuit rupture, air embolism, power failure) safely, building teamwork and response automaticity.
Question 4: A family meeting for a patient on VA ECMO for refractory cardiogenic shock should address:
- Only the technical aspects of the ECMO circuit
- Goals of care, expected timeline, possible outcomes, and decision points if recovery does not occur (Correct answer)
- Only nursing care activities
- Insurance coverage for ECMO
Correct answer: Goals of care, expected timeline, possible outcomes, and decision points if recovery does not occur
Family meetings must address prognosis, goals of care, realistic outcomes, and decision frameworks including withdrawal if the patient does not improve.
Question 5: When an ECMO patient is transferred to another facility, which document must accompany the patient?
- Insurance pre-authorization only
- Complete ECMO circuit log, current parameter settings, and transport medication/anticoagulation plan (Correct answer)
- Billing records
- Only the most recent ABG result
Correct answer: Complete ECMO circuit log, current parameter settings, and transport medication/anticoagulation plan
A complete ECMO circuit log, current settings documentation, and a transport anticoagulation/medication plan are essential for safe inter-facility ECMO transport.
Question 6: Which communication failure is most associated with ECMO adverse events according to quality reviews?
- Failure to notify laboratory of specimen priority
- Inadequate handoff of circuit status and recent alarms (Correct answer)
- Delay in notifying dietary of NPO status
- Failure to update family contact information
Correct answer: Inadequate handoff of circuit status and recent alarms
Inadequate handoff communication of circuit parameters and unresolved alarms is consistently identified in ECMO adverse event analyses.
CES ECMO Team Roles & Communication 2
What is the minimum recommended ECMO specialist-to-patient ratio during active ECMO support?