ECMO ECMO Pharmacology and Drug Management 3

Question 1

Which pharmacokinetic parameter is most significantly increased by ECMO in critically ill patients?

Accepted Answer

Volume of distribution (Vd)

Answer

ECMO increases the apparent volume of distribution by sequestering lipophilic drugs into circuit components and the large priming volume.

Question 2

Corticosteroid therapy in VA-ECMO patients with refractory vasodilatory shock is aimed at treating:

Accepted Answer

Critical illness-related corticosteroid insufficiency (CIRCI)

Answer

CIRCI causes impaired cortisol response to stress, and hydrocortisone supplementation can restore vasopressor responsiveness in refractory shock.

Question 3

Argatroban, used in HIT patients on ECMO, is monitored using which laboratory test?

Accepted Answer

Activated clotting time (ACT) or aPTT

Answer

Argatroban is monitored via aPTT (target 1.5–3× baseline) or ACT, as it directly inhibits thrombin and prolongs clot-based assays.

Question 4

Milrinone is sometimes used in ECMO patients because it improves cardiac function by:

Accepted Answer

Inhibiting phosphodiesterase III to increase cAMP and improve contractility with vasodilation

Answer

Milrinone's PDE-III inhibition raises intracellular cAMP, producing positive inotropy and systemic vasodilation, useful for low cardiac output states.

Question 5

Which packed red blood cell (pRBC) transfusion threshold is commonly targeted in stable VV-ECMO patients without active hemorrhage?

Accepted Answer

Hgb <10 g/dL

Answer

Most ECMO centers target hemoglobin >10 g/dL to optimize oxygen delivery through the circuit to the patient.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO ECMO Pharmacology and Drug Management 3