CES ECMO Weaning & Decannulation 3

Question 1

The 'ECMO-off' test in VV ECMO involves which specific maneuver?

Accepted Answer

Clamping both the drainage and return limbs with the circuit recirculating for 5–10 minutes while monitoring gases

Answer

Clamping both ECMO limbs while recirculating allows assessment of native lung gas exchange without any ECMO support for a brief trial period.

Question 2

Which ventilator strategy is recommended before attempting VV ECMO weaning to protect the recovering lung?

Accepted Answer

High PEEP and low tidal volume (lung-protective ventilation)

Answer

Lung-protective ventilation with low tidal volumes and appropriate PEEP should be confirmed adequate before and during weaning to prevent re-injury.

Question 3

After successful ECMO weaning, anticoagulation is typically:

Accepted Answer

Transitioned to prophylactic dosing or bridged to oral anticoagulation based on indication

Answer

Post-decannulation anticoagulation is individualized — prophylactic dosing or bridging to oral agents is common depending on thrombosis risk and bleeding history.

Question 4

What echo parameter during a VA ECMO weaning trial at 1 L/min flow best predicts successful decannulation?

Accepted Answer

LVEF > 35% and LVOT VTI > 12 cm

Answer

LVEF > 35% combined with LVOT VTI > 12 cm at minimal ECMO support correlates with sufficient cardiac recovery for decannulation.

Question 5

Which parameter indicates successful weaning from neonatal VV ECMO in a term infant?

Accepted Answer

PaO2 > 60 mmHg on FiO2 0.4 with sweep gas off

Answer

Maintaining PaO2 > 60 mmHg on FiO2 ≤ 0.4 with sweep gas turned off demonstrates sufficient native lung recovery in neonates.

CES - Certified ECMO Specialist Practice Test

CES - Certified ECMO Specialist Practice Test

CES ECMO Weaning & Decannulation 3