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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. Which condition would most likely prompt conversion from VV to VA ECMO in a patient already on VV support?

    Answer: Progressive cardiogenic shock with hemodynamic deterioration

    VV ECMO provides only respiratory support; progressive cardiogenic shock requiring hemodynamic support necessitates conversion to VA ECMO, which also offloads the failing heart.

  2. A VV ECMO patient's sweep gas accidentally becomes disconnected for 3 minutes. What is the expected physiologic consequence?

    Answer: Rapid hypoxemia and hypercapnia

    Loss of sweep gas eliminates both O2 transfer and CO2 removal across the membrane, causing rapid hypoxemia and hypercapnia.

  3. During VV ECMO, thrombocytopenia and prolonged aPTT develop simultaneously. Anti-PF4 antibody is strongly positive. What is the recommended treatment?

    Answer: Stop heparin and switch to a direct thrombin inhibitor (bivalirudin or argatroban)

    Positive anti-PF4 antibody confirms heparin-induced thrombocytopenia; heparin must be stopped and replaced with a non-heparin anticoagulant such as bivalirudin.

  4. What is the significance of a 'chattering' or 'sucking' cannula during VV ECMO?

    Answer: It signals that drainage is impaired, usually from hypovolemia or cannula malposition

    Cannula chattering occurs when the circuit intermittently collapses venous inflow, indicating inadequate preload or a positional drainage issue requiring immediate attention.

  5. A VV ECMO patient with ARDS is being weaned. During a 4-hour trial with sweep gas at 0 L/min, PaO2 is 72 mmHg on FiO2 0.4. Ventilator settings are Vt 6 mL/kg, PEEP 10 cmH2O, RR 20. What is the appropriate next step?

    Answer: Immediately decannulate the patient

    PaO2 >65 mmHg on FiO2 ≤0.4 and acceptable ventilator parameters during a sweep-off trial indicate adequate native lung recovery and readiness for decannulation.

  6. Which physiologic difference distinguishes VV from VA ECMO regarding oxygen delivery to the coronary arteries?

    Answer: In VV ECMO, oxygenated blood mixes with desaturated blood in the right heart and must traverse the native cardiopulmonary circulation before reaching coronary arteries

    In VV ECMO, oxygenated blood returned to the right atrium mixes with desaturated blood and must pass through the native lungs before reaching the left heart and coronary circulation.

  7. Which parameter should be checked when a VV ECMO patient receiving therapeutic anticoagulation unexpectedly develops widespread circuit clotting?

    Answer: Antithrombin III (AT-III) level

    Heparin requires antithrombin III to exert its anticoagulant effect; AT-III deficiency causes heparin resistance and circuit thrombosis despite therapeutic dosing.