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
Which neonatal cardiac diagnosis most commonly requires ECMO support in the immediate post-operative period?
Answer: Hypoplastic left heart syndrome (HLHS) after Norwood procedure
HLHS after Norwood palliation carries the highest rate of post-operative ECMO requirement due to single-ventricle physiology and complex hemodynamics.
A trauma patient on ECPR after traumatic cardiac arrest has ongoing abdominal hemorrhage. The most appropriate anticoagulation management is:
Answer: Heparin-free ECMO circuit with careful monitoring
Heparin-free or minimally heparinized ECMO is used in active hemorrhage to balance circuit thrombosis risk against life-threatening bleeding.
During ECPR for a patient in status asthmaticus cardiac arrest, which ventilator strategy is most appropriate once on ECMO?
Answer: Permissive hypercapnia with prolonged expiratory time and low PEEP
Status asthmaticus requires permissive hypercapnia, very low respiratory rates, and prolonged expiratory time to prevent dynamic hyperinflation; ECMO manages gas exchange.
In ECPR for a patient with pulmonary embolism (PE), which additional therapeutic intervention has the strongest evidence as an adjunct to ECMO?
Answer: Catheter-directed thrombolysis or surgical embolectomy
Surgical embolectomy or catheter-directed intervention definitively removes the clot burden and is preferred in massive PE on ECMO to restore right ventricular function.
What is the recommended activated clotting time (ACT) target range for ECPR in a pediatric patient without active bleeding?
Answer: 160–200 seconds
ACT targets of 160–200 seconds balance circuit thrombosis prevention with bleeding risk in pediatric ECMO patients without active hemorrhage.
Which finding on cranial ultrasound in a neonate on ECMO is an absolute contraindication to continuing ECMO support?
Answer: Grade III–IV intraventricular hemorrhage
Grade III–IV IVH carries a very high risk of death or severe neurodevelopmental disability, and is an absolute contraindication due to anticoagulation requirements worsening hemorrhage.
In post-cardiac surgery ECPR, the 'Berlin criteria' for ECMO candidacy emphasize which factor as most predictive of survival to discharge?
Answer: Lactate below 15 mmol/L at ECMO initiation
Lactate below 15 mmol/L at ECMO initiation is the strongest predictor of survival in post-cardiotomy ECMO patients, reflecting residual metabolic reserve.