CES ECMO Weaning & Decannulation 2 — Questions and Answers
Question 1: After successful decannulation of a femoral arterial VA ECMO cannula, the preferred method of hemostasis is:
- Manual compression for 30 minutes minimum
- Figure-of-eight suture with surgical cut-down or purse-string closure (Correct answer)
- Immediate application of a topical hemostatic agent only
- Endovascular plug deployment
Correct answer: Figure-of-eight suture with surgical cut-down or purse-string closure
Femoral arterial decannulation typically requires surgical closure (figure-of-eight or purse-string suture) due to the large-bore cannula size.
Question 2: Limb ischemia distal to a femoral arterial ECMO cannula is best managed by:
- Immediate decannulation
- Insertion of a distal perfusion cannula (DPC) in the superficial femoral artery (Correct answer)
- Elevation of the affected limb
- Increasing heparin dosing only
Correct answer: Insertion of a distal perfusion cannula (DPC) in the superficial femoral artery
A distal perfusion cannula inserted into the superficial femoral artery restores antegrade flow to the ischemic limb during ongoing ECMO support.
Question 3: Which sign during VV ECMO decannulation indicates a potentially dangerous air embolism risk?
- Venous cannula positioned in the IVC
- Patient coughing or taking deep breath during cannula removal (Correct answer)
- High ECMO flow rates just before removal
- Low ACT at time of decannulation
Correct answer: Patient coughing or taking deep breath during cannula removal
Inspiration during venous decannulation creates negative intrathoracic pressure that can entrain air through the open cannulation site into the venous system.
Question 4: What Trendelenburg positioning maneuver during venous decannulation helps prevent air embolism?
- 10° reverse Trendelenburg (head up)
- 15–30° Trendelenburg (head down) (Correct answer)
- Left lateral decubitus position
- No positioning change is needed
Correct answer: 15–30° Trendelenburg (head down)
Trendelenburg (head-down) positioning raises venous pressure at the cannulation site, reducing the risk of air entrainment during decannulation.
Question 5: Following decannulation, how long is bed rest typically recommended after femoral venous ECMO cannula removal?
- 1–2 hours
- 4–6 hours (Correct answer)
- 12–24 hours
- 48 hours
Correct answer: 4–6 hours
Approximately 4–6 hours of bed rest after femoral venous decannulation is standard practice to ensure hemostasis and prevent hematoma formation.
Question 6: Which post-decannulation complication is most common after femoral VA ECMO?
- Retroperitoneal hematoma
- Lymphocele formation
- Femoral artery pseudoaneurysm or hematoma (Correct answer)
- Deep vein thrombosis
Correct answer: Femoral artery pseudoaneurysm or hematoma
Femoral artery pseudoaneurysm and local hematoma are the most frequently reported vascular complications following femoral arterial VA ECMO decannulation.
CES ECMO Weaning & Decannulation 2
After successful decannulation of a femoral arterial VA ECMO cannula, the preferred method of hemostasis is: