ECMO ECMO Pharmacology and Drug Management 2 — Questions and Answers
Question 1: Nitric oxide (NO) can be administered to ECMO patients by delivering it through which component of the circuit?
- The venous drainage cannula
- The sweep gas inlet of the oxygenator (Correct answer)
- The arterial return cannula
- The hemofilter port
Correct answer: The sweep gas inlet of the oxygenator
Inhaled nitric oxide can be blended into the sweep gas of the ECMO oxygenator to achieve selective pulmonary vasodilation.
Question 2: A major concern with high-dose propofol infusions in ECMO patients is development of:
- Hepatic encephalopathy
- Propofol infusion syndrome (PRIS) (Correct answer)
- Adrenal insufficiency
- Neuroleptic malignant syndrome
Correct answer: Propofol infusion syndrome (PRIS)
Propofol infusion syndrome, characterized by metabolic acidosis, rhabdomyolysis, and cardiac failure, is a rare but life-threatening complication at high doses.
Question 3: Succinylcholine use in critically ill ECMO patients carries a risk of life-threatening:
- Malignant hyperthermia
- Hyperkalemia-induced cardiac arrest (Correct answer)
- Prolonged paralysis due to circuit sequestration
- Bronchospasm
Correct answer: Hyperkalemia-induced cardiac arrest
Critically ill patients often have upregulated acetylcholine receptors, and succinylcholine depolarization releases enough potassium to cause cardiac arrest.
Question 4: Which neuromuscular blocking agent is preferred for paralysis in VV-ECMO patients with severe ARDS?
- Succinylcholine
- Pancuronium
- Cisatracurium (Correct answer)
- Rocuronium
Correct answer: Cisatracurium
Cisatracurium is preferred in severe ARDS on ECMO because it undergoes Hofmann elimination independent of organ function and has fewer cardiovascular side effects.
Question 5: What is the standard ICU blood glucose target for ECMO patients receiving insulin infusion therapy?
- 60–100 mg/dL
- 100–140 mg/dL
- 140–180 mg/dL (Correct answer)
- 180–220 mg/dL
Correct answer: 140–180 mg/dL
Current critical care guidelines recommend targeting blood glucose of 140–180 mg/dL to balance glycemic control with hypoglycemia risk.
Question 6: Loop diuretics such as furosemide are used in ECMO patients primarily to:
- Prevent circuit thrombosis
- Reduce fluid overload and improve oxygenation (Correct answer)
- Increase cardiac output
- Correct metabolic alkalosis
Correct answer: Reduce fluid overload and improve oxygenation
Fluid overload is common in ECMO patients due to capillary leak and transfusion requirements; furosemide promotes diuresis to reduce lung edema.
ECMO ECMO Pharmacology and Drug Management 2
Nitric oxide (NO) can be administered to ECMO patients by delivering it through which component of the circuit?