ECMO Cheat Sheet 2026

The 30 highest-yield ECMO facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. The primary goal of ECMO support in pediatric myocarditis is: → Bridging to myocardial recovery or cardiac transplantation
2. Is there a prehospital protocol for ECPR (refractory arrest, “ECMO Alert”) activation when I am taking a patient to one of the hospitals with an ECPR program? → Yes, there is a protocol that includes age, initial rhythm, and arrest witnessed criteria.
3. Which component of the ECMO circuit is directly responsible for both oxygenating the blood and removing carbon dioxide? → Membrane oxygenator
4. Which metabolic disturbance is most commonly associated with ECMO-induced systemic inflammatory response? → Hyperglycemia
5. Nitric oxide (NO) can be administered to ECMO patients by delivering it through which component of the circuit? → The sweep gas inlet of the oxygenator
6. Which ECMO configuration is most commonly used in neonates requiring support? → Veno-arterial (VA) ECMO via neck vessels
7. What are the two most commonly used types of ECMO? → Veno-venous (VV) ECMO and Veno-arterial (VA) ECMO
8. When initiating enteral nutrition in an ECMO patient, what is the recommended timing after circuit initiation in a hemodynamically stable patient? → Within 24–48 hours
9. How does the ECMO circuit most directly impact drug and nutrient pharmacokinetics? → It sequesters lipophilic drugs and nutrients within the circuit tubing and oxygenator
10. In pediatric ECMO for cardiac support, the most common underlying diagnosis requiring support is: → Post-cardiac surgery congenital heart disease
11. What is the primary function of ECMO in respiratory failure? → To provide oxygenation and remove carbon dioxide
12. Why are the first 16 minutes of a cardiac arrest so important? → Most patients with good neurological outcomes achieve ROSC within the first 16 minutes.
13. What are the indications for use of ECMO? → Ventricular fibrillation cardiac arrest and acute respiratory distress syndrome (ARDS)
14. What is the primary concern regarding bleeding in patients on ECMO? → Blood clot formation
15. Which of the following clinical findings is the most direct and visually apparent indicator of significant intravascular hemolysis in a patient on ECMO? → Dark, tea-colored urine in the urinary drainage bag.
16. We can potentially use ECPR (refractory arrest) for cardiac arrests in V-fib and V-tach, why can’t we use it for asystole? → Asystole often indicates non-cardiogenic causes of arrest.
17. What is the most appropriate strategy for managing hyperglycemia in an ECMO patient receiving continuous enteral nutrition? → Use a continuous insulin infusion titrated per a validated insulin protocol
18. Argatroban, used in HIT patients on ECMO, is monitored using which laboratory test? → Activated clotting time (ACT) or aPTT
19. A neonate on femoral VA-ECMO develops progressive ipsilateral lower extremity ischemia. The most appropriate intervention is: → Insert a distal perfusion catheter into the superficial femoral artery
20. Which of the following clinical signs is the most specific indicator of an impending oxygenator failure due to plasma leak? → Frothy, pink-tinged fluid appearing in the oxygenator's gas exhaust port.
21. The oxygenation index (OI) threshold commonly used to consider ECMO in neonates is: → >40
22. A centrifugal pump is the most common type used in adult ECMO circuits. A key characteristic of a centrifugal pump is that its flow is: → Preload dependent and afterload sensitive
23. Which packed red blood cell (pRBC) transfusion threshold is commonly targeted in stable VV-ECMO patients without active hemorrhage? → Hgb <10 g/dL
24. What is the primary mechanism of gas exchange in veno-venous ECMO? → Diffusion across the membrane
25. What minimum body weight is typically required for neonatal ECMO candidacy at most US centers? → 2.0 kg
26. Corticosteroid therapy in VA-ECMO patients with refractory vasodilatory shock is aimed at treating: → Critical illness-related corticosteroid insufficiency (CIRCI)
27. What is the preferred route of nutritional support for hemodynamically stable ECMO patients? → Enteral nutrition via nasogastric or nasoenteric tube
28. Prolonged aminoglycoside use in ECMO patients requires monitoring for which organ-specific toxicity? → Nephrotoxicity and ototoxicity
29. Which antifungal agent demonstrates clinically significant sequestration in ECMO circuits due to its lipophilic properties? → Voriconazole
30. Which pharmacokinetic parameter is most significantly increased by ECMO in critically ill patients? → Volume of distribution (Vd)