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Veno-Venous (VV) 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-Venous (VV) ECMO Management flashcards as text

  1. A VV ECMO patient has adequate oxygenation but develops progressive hypercapnia despite maximum sweep gas settings. What is the next step?

    Answer: Evaluate for membrane oxygenator clot or plasma leak

    Plasma leak or thrombus within the oxygenator impairs gas exchange efficiency, causing CO2 retention despite maximal sweep settings.

  2. Which anticoagulation monitoring strategy is most commonly used during VV ECMO in adults?

    Answer: Activated partial thromboplastin time (aPTT) with unfractionated heparin

    Unfractionated heparin titrated to aPTT (typically 60–80 seconds) is the most widely used anticoagulation strategy in adult VV ECMO.

  3. During VV ECMO, a patient develops acute hemolysis (plasma-free hemoglobin >500 mg/dL). What is the FIRST action?

    Answer: Inspect the circuit for thrombus, kinks, or high negative inlet pressure

    Hemolysis on ECMO is often caused by mechanical factors (thrombus, kinking, cavitation from excessive negative pressure), which must be identified and corrected first.

  4. What is the recommended target activated clotting time (ACT) range for most adult VV ECMO patients using unfractionated heparin?

    Answer: 160–200 seconds

    Most centers target an ACT of 160–200 seconds on VV ECMO, balancing thrombosis prevention against bleeding risk.

  5. A VV ECMO patient requires a blood transfusion. Which hemoglobin threshold is most appropriate for initiating transfusion in a stable patient?

    Answer: Hgb < 8 g/dL

    Most ECMO centers use a hemoglobin threshold of 8 g/dL for transfusion, as higher hemoglobin improves oxygen-carrying capacity on ECMO support.

  6. Which complication is unique to the bicaval dual-lumen (Avalon) cannula approach for VV ECMO compared to femoral-jugular configuration?

    Answer: Cardiac perforation during insertion

    The stiff bicaval dual-lumen cannula can perforate the right atrium or superior vena cava during insertion, a risk not present with soft femoral-jugular cannulas.

  7. A VV ECMO patient on lung-rest ventilation (Vt 2–3 mL/kg, rate 10) suddenly desaturates to 70%. ECMO flows are unchanged at 5 L/min. What is the most important immediate assessment?

    Answer: Assess cannula position and circuit for obstruction

    Sudden desaturation with unchanged ECMO flows suggests acute cannula malposition, kinking, or obstruction reducing effective circuit flow.