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Veno-Arterial (VA) ECMO Management 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 Veno-Arterial (VA) ECMO Management flashcards as text

  1. During VA ECMO, which strategy is used to vent the left ventricle percutaneously without additional surgery?

    Answer: Impella device placed across the aortic valve

    An Impella device positioned across the aortic valve provides active LV unloading and venting, reducing distension during VA ECMO support.

  2. What is the primary reason VA ECMO increases myocardial oxygen demand compared to VV ECMO?

    Answer: Increased LV afterload from retrograde aortic flow

    Retrograde ECMO flow into the aorta increases LV afterload, forcing the recovering heart to work harder and increasing myocardial oxygen consumption.

  3. A VA ECMO circuit suddenly shows decreased flow with increasing inlet pressure. The most likely cause is:

    Answer: Venous cannula malposition or hypovolemia

    Decreased flow with high negative inlet (suction) pressure indicates inadequate venous drainage, most often from cannula malposition or hypovolemia causing suction events.

  4. In cardiogenic shock treated with VA ECMO, which laboratory value most directly reflects tissue oxygen delivery adequacy?

    Answer: Serum lactate trend

    Serial lactate trending is the most direct indicator of whether tissue oxygen delivery is adequate, with falling lactate confirming successful resuscitation.

  5. What is the recommended ECMO blood flow rate (as % of cardiac output) to achieve adequate systemic support in cardiogenic shock?

    Answer: 60–80%

    VA ECMO typically targets 60–80% of the patient's estimated cardiac output (approximately 3–4 L/min) to provide adequate systemic perfusion.

  6. Which complication is specifically associated with VA ECMO but NOT VV ECMO?

    Answer: Systemic arterial embolism

    Systemic arterial embolism is unique to VA ECMO because air or thrombus entering the arterial circuit is delivered directly into the systemic circulation, unlike VV ECMO.

  7. A patient being weaned from VA ECMO has ECMO flow reduced to 1 L/min. Which hemodynamic parameter should be monitored most closely?

    Answer: Arterial pulse pressure and mean arterial pressure

    During weaning trials, arterial pulse pressure (indicating native stroke volume) and MAP are the primary indicators of whether the heart can sustain adequate perfusion without full ECMO support.