ECMO ECMO in Neonatal and Pediatric Populations 2 — Questions and Answers
Question 1: Why is the right common carotid artery preferred over femoral access for arterial cannulation in neonatal VA-ECMO?
- It has a larger diameter than femoral vessels in neonates
- It provides direct retrograde perfusion to the aortic arch without lower limb ischemia risk (Correct answer)
- It allows higher ECMO flow rates
- It is easier to repair after decannulation
Correct answer: It provides direct retrograde perfusion to the aortic arch without lower limb ischemia risk
Carotid cannulation provides central oxygenated blood delivery to the aorta and coronaries without risking lower extremity ischemia from femoral cannulas.
Question 2: Which complication is most feared in premature neonates on ECMO and contributes to its status as a relative contraindication in this population?
- Sepsis from circuit exposure
- Intracranial hemorrhage (ICH) (Correct answer)
- Renal failure from pump-related hemolysis
- Hypoglycemia from glucose consumption
Correct answer: Intracranial hemorrhage (ICH)
The immature germinal matrix in premature neonates is highly susceptible to hemorrhage during ECMO anticoagulation, often resulting in fatal or severely disabling ICH.
Question 3: The ELSO (Extracorporeal Life Support Organization) registry reports the highest survival rates among which ECMO patient group?
- Neonatal cardiac ECMO
- Pediatric cardiac ECMO
- Neonatal respiratory ECMO (Correct answer)
- Adult respiratory ECMO
Correct answer: Neonatal respiratory ECMO
Neonatal respiratory ECMO has the best outcomes, with survival to discharge approximately 73% according to ELSO registry data.
Question 4: What platelet count is typically targeted in pediatric ECMO patients to reduce bleeding risk without compromising circuit function?
- >50,000/μL
- >80,000/μL
- >100,000/μL (Correct answer)
- >150,000/μL
Correct answer: >100,000/μL
Most pediatric ECMO centers target platelet counts >100,000/μL because thrombocytopenia is common due to platelet consumption by the circuit.
Question 5: In pediatric ECMO for cardiac support, the most common underlying diagnosis requiring support is:
- Myocarditis
- Post-cardiac surgery congenital heart disease (Correct answer)
- Dilated cardiomyopathy
- Long QT syndrome with refractory arrhythmia
Correct answer: Post-cardiac surgery congenital heart disease
Post-operative low cardiac output syndrome following congenital heart disease repair is the leading indication for pediatric cardiac ECMO.
Question 6: Which scoring tool based on ELSO registry data is used to estimate survival probability in neonates on ECMO?
- APACHE II
- PRISM III
- Neonatal ECMO Predicted Survival Score (Correct answer)
- SOFA score
Correct answer: Neonatal ECMO Predicted Survival Score
Survival prediction models derived from ELSO registry data stratify neonatal ECMO outcomes by diagnosis, helping guide counseling and resource allocation.
ECMO ECMO in Neonatal and Pediatric Populations 2
Why is the right common carotid artery preferred over femoral access for arterial cannulation in neonatal VA-ECMO?