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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. Which pharmacological agent is most commonly used to reduce LV afterload and facilitate LV ejection in VA ECMO patients?

    Answer: Nitroprusside or milrinone

    Vasodilators like nitroprusside or inodilators like milrinone reduce systemic vascular resistance, helping the LV eject against the increased afterload imposed by VA ECMO.

  2. When should anticoagulation be withheld or minimized during VA ECMO?

    Answer: In the presence of active life-threatening hemorrhage

    Active life-threatening hemorrhage may require temporarily reducing or withholding anticoagulation despite the risk of circuit thrombosis.

  3. Which factor most directly determines the maximum blood flow achievable in a VA ECMO circuit?

    Answer: Venous cannula size and venous drainage

    Venous drainage is the limiting factor in ECMO flow; the venous cannula size and position determine how much blood can be returned to the pump.

  4. In post-cardiotomy cardiogenic shock, VA ECMO is initiated. After 72 hours, there is no evidence of cardiac recovery. What is the next appropriate step?

    Answer: Evaluate for advanced therapies: LVAD or cardiac transplantation

    Absence of cardiac recovery at 72–96 hours should prompt evaluation for durable mechanical circulatory support (LVAD) or cardiac transplantation as bridge therapies.

  5. What is the effect of increasing ECMO pump speed (RPM) in a patient with severe aortic regurgitation on VA ECMO?

    Answer: It worsens LV distension by increasing retrograde regurgitant volume

    In severe aortic regurgitation, higher ECMO flow increases retrograde pressure in the aortic root, worsening the degree of regurgitation and LV volume overload.

  6. A VA ECMO patient develops white discoloration of the toes on the cannulated leg despite a functioning distal perfusion cannula. The next step is:

    Answer: Reassess DPC position and flow with Doppler ultrasound

    Persistent limb ischemia despite a DPC requires Doppler assessment to confirm cannula patency and adequate flow, as the DPC may be kinked, clotted, or malpositioned.

  7. What is the primary goal of parallel venoarterial-venous (VAV) ECMO configuration?

    Answer: Treat both respiratory failure and cardiogenic shock simultaneously

    VAV ECMO simultaneously addresses biventricular failure and severe respiratory failure by delivering oxygenated blood to both the pulmonary and systemic circulations.