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Weaning and Decannulation 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 Weaning and Decannulation flashcards as text

  1. During VV-ECMO weaning, which parameter most reliably indicates adequate native lung recovery before a trial off?

    Answer: SpO2 > 95% on FiO2 ≤ 0.4 with sweep gas off

    SpO2 >95% with acceptable PaCO2 on room-air sweep-off conditions demonstrates that native lungs can sustain gas exchange independently.

  2. A patient on VA-ECMO for cardiogenic shock undergoes a 30-minute clamp trial. During the trial, the arterial pressure waveform becomes pulsatile with a pulse pressure of 40 mmHg. This finding indicates:

    Answer: Adequate left ventricular recovery to consider decannulation

    A robust pulsatile waveform during VA-ECMO clamping reflects meaningful left ventricular stroke volume, suggesting cardiac recovery.

  3. Which echocardiographic finding during a VA-ECMO weaning trial would most strongly support proceeding to decannulation?

    Answer: LVEF ≥ 35% with no severe valvular abnormality

    LVEF ≥ 35% without severe valvular disease suggests sufficient cardiac reserve to sustain circulation without ECMO support.

  4. When weaning VV-ECMO, the sweep gas flow is progressively reduced. What physiologic effect does reducing sweep gas primarily alter?

    Answer: Carbon dioxide removal by the oxygenator

    Sweep gas flow controls the rate of CO2 removal across the membrane; reducing it raises PaCO2 and stimulates native respiratory drive.

  5. After surgical decannulation of a femoral venous cannula, the preferred method for achieving hemostasis at the venous access site in a fully anticoagulated patient is:

    Answer: Manual pressure for 30–45 minutes followed by a pressure dressing

    Sustained manual compression for 30–45 minutes is standard practice for venous cannula sites, followed by a firm pressure dressing.

  6. During a VA-ECMO weaning trial at reduced flow (1 L/min), the patient develops hypotension (MAP 55 mmHg) and mottled extremities. The appropriate immediate action is:

    Answer: Return ECMO flow to full support and reassess in 24–48 hours

    Hemodynamic deterioration during a weaning trial indicates the patient is not ready; restoring full flow and deferring decannulation is the safe response.

  7. A key advantage of a percutaneous 'Z-stitch' purse-string suture placed at the time of cannulation is that it:

    Answer: Allows rapid hemostasis at decannulation without surgical exploration

    The pre-placed purse-string suture can be tightened and tied at the moment the cannula is withdrawn, achieving immediate hemostasis percutaneously.