ECMO - Extracorporeal Membrane Oxygenation Veno-Arterial (VA) ECMO Management Questions and Answers

Question 1

A patient on peripheral VA ECMO for acute myocardial infarction develops progressive pulmonary edema, a pulse pressure of less than 10 mmHg, and an echocardiogram showing a persistently closed aortic valve.
These findings are most indicative of which critical complication?

Accepted Answer

Left ventricular (LV) distension

Answer

Inadequate venous drainage from cannula malposition

Answer

Massive pulmonary embolism

Answer

Aortic dissection from the arterial cannula

Question 2

Which of the following findings is the most reliable indicator of sufficient myocardial recovery to begin a weaning trial from VA ECMO?

Accepted Answer

Consistent arterial line pulsatility and an LV outflow tract VTI > 10 cm on echocardiography

Answer

Normalization of the patient's body temperature and white blood cell count

Answer

A chest X-ray showing resolution of pulmonary edema

Answer

The ability to decrease the sweep gas flow to zero without a rise in PaCO2

Question 3

A patient on VA ECMO is receiving a heparin infusion with a target aPTT of 60-80 seconds. The most recent aPTT is 110 seconds, and there is new, significant oozing from the cannula insertion sites. Which is the most appropriate immediate action?

Accepted Answer

Decrease or temporarily hold the heparin infusion and re-evaluate

Answer

Administer fresh frozen plasma (FFP) and cryoprecipitate

Answer

Increase the ECMO blood flow to improve circuit dynamics

Answer

Administer a dose of protamine sulfate to fully reverse the heparin

Question 4

In a patient on full-flow peripheral VA ECMO for cardiogenic shock, which hemodynamic pressure is most directly and significantly reduced as a consequence of the circuit's function?

Accepted Answer

Pulmonary Artery (PA) pressure

Answer

Mean Arterial Pressure (MAP)

Answer

Systemic Vascular Resistance (SVR)

Answer

Central Venous Pressure (CVP)

Question 5

A patient on femoral VA ECMO for severe respiratory failure with secondary cardiac dysfunction begins to show signs of myocardial recovery. The monitor shows a right radial SpO2 of 88% while the lower extremity SpO2 is 99%. Which is the most appropriate initial intervention to manage this differential hypoxia (Harlequin syndrome)?

Accepted Answer

Optimize mechanical ventilation by increasing FiO2 and PEEP

Answer

Increase the ECMO pump flow to maximum to override native cardiac output

Answer

Administer a negative inotrope to suppress native cardiac function

Answer

Immediately convert the patient to a Veno-Venous (VV) ECMO configuration

Question 6

Which of the following is a standard, non-invasive, continuous monitoring modality used for the early detection of cerebral malperfusion or ischemic events in an adult patient on VA ECMO?

Accepted Answer

Near-infrared spectroscopy (NIRS) for cerebral oximetry

Answer

Daily transcranial Doppler (TCD) ultrasounds

Answer

Serial serum S100B protein measurements

Answer

Continuous electroencephalography (EEG)