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ECPR and Special Populations 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 ECPR and Special Populations flashcards as text

  1. Which ECMO configuration is preferred for ECPR in a patient with severe pulmonary hypertension as the cause of cardiac arrest?

    Answer: VA-ECMO via right atrium to pulmonary artery (PA)

    Right atrium to pulmonary artery ECMO directly unloads the right ventricle, which is the failing chamber in severe pulmonary hypertension.

  2. In ECPR for pediatric myocarditis, which echocardiographic finding would most support initiating ECMO support?

    Answer: EF < 25% with biventricular dilation

    Severely reduced EF below 25% with biventricular dilation in myocarditis indicates cardiogenic shock unresponsive to conventional therapy, supporting ECMO initiation.

  3. When performing ECPR on a patient with a known bleeding disorder (hemophilia A), the anticoagulation strategy should be modified to:

    Answer: Replace UFH with bivalirudin and target lower ACT

    Bivalirudin avoids heparin resistance and allows direct thrombin inhibition while targeting a lower ACT to reduce bleeding risk in coagulopathic patients.

  4. What is the primary reason ECPR outcomes in out-of-hospital cardiac arrest (OHCA) are inferior to in-hospital cardiac arrest (IHCA)?

    Answer: Longer no-flow and low-flow times in OHCA

    OHCA results in longer periods of no-flow and low-flow before ECPR initiation, leading to greater ischemic injury compared to IHCA.

  5. In a septic patient on VA-ECMO after ECPR, which hemodynamic finding indicates the ECMO is adequately offloading the left ventricle?

    Answer: Non-pulsatile arterial trace with narrow pulse pressure

    A non-pulsatile, narrow pulse-pressure arterial trace indicates the ECMO is providing most of the cardiac output, minimizing LV work.

  6. For ECPR in a patient with a previous coronary artery bypass graft (CABG), which additional intervention is most commonly required alongside ECMO?

    Answer: Urgent percutaneous coronary intervention (PCI) of the culprit graft

    ECPR stabilizes the post-CABG patient hemodynamically while urgent PCI addresses acute graft failure or native vessel occlusion as the arrest etiology.

  7. Which blood gas parameter is the primary driver for adjusting sweep gas flow rate on the ECMO circuit during ECPR?

    Answer: PaCO2

    Sweep gas flow rate primarily controls CO2 removal; increasing sweep flow decreases PaCO2 and increasing oxygenation is managed separately via FiO2.