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Complications and Troubleshooting Flashcards

7 cards from real ECMO practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Complications and Troubleshooting flashcards as text

  1. During ECMO, the team notices pink frothy fluid in the sweep gas exhaust. What does this indicate?

    Answer: Plasma leak through the oxygenator membrane

    Pink frothy fluid in the sweep gas exhaust indicates plasma leakage across the oxygenator membrane, which can reduce gas exchange efficiency and require oxygenator replacement.

  2. A VA-ECMO patient on full support suddenly develops pulsatile arterial waveforms with increased mean arterial pressure. This most likely indicates:

    Answer: Recovery of native cardiac function

    Return of pulsatility on VA-ECMO signifies improved native cardiac contractility, which is a positive sign of cardiac recovery.

  3. An ECMO patient develops hemoglobinuria. The initial management step should be to:

    Answer: Increase urine output with fluids and loop diuretics to protect kidneys

    Hemolysis-induced hemoglobinuria can cause acute kidney injury; aggressive diuresis and urine alkalinization help protect renal tubules while the hemolysis source is investigated.

  4. Plasma-free hemoglobin (pfHgb) is measured at 800 mg/dL in an ECMO patient. What circuit issue should be investigated first?

    Answer: High pump speed causing cavitation and RBC destruction

    Elevated pfHgb indicates hemolysis, commonly caused by excessive pump speed generating shear stress that destroys red blood cells.

  5. A patient on ECMO develops fever to 39.8°C with positive blood cultures for Candida. The most appropriate step regarding the ECMO circuit is:

    Answer: Change the entire ECMO circuit and cannulas

    Fungal bloodstream infections in ECMO patients require circuit and cannula change, as biofilm on surfaces cannot be sterilized with systemic antifungals alone.

  6. Differential hypoxia (Harlequin syndrome) in VA-ECMO via femoral cannulation is characterized by:

    Answer: Oxygenated lower body from ECMO and hypoxic upper body from native lungs

    In femoral VA-ECMO, oxygenated ECMO blood enters the aorta retrogradely and perfuses the lower body, while the upper body receives deoxygenated blood from the recovering but still-dysfunctional native lungs.

  7. During ECMO transport, the centrifugal pump controller alarms 'low flow' and flow drops to 0.5 L/min. The first action should be:

    Answer: Assess for tubing kinks, positional cannula obstruction, or hypovolemia

    Low flow during transport is most commonly due to mechanical obstruction from kinked tubing or positional cannula issues, and a systematic circuit check must occur before escalating interventions.