Weaning and Decannulation Flashcards
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Read the first 7 Weaning and Decannulation flashcards as text
Which hemodynamic goal during a VA-ECMO weaning trial best predicts successful decannulation?
Answer: Maintaining MAP > 65 mmHg on low-dose vasopressors with ECMO flow ≤ 1.5 L/min
Hemodynamic stability with minimal vasopressor support at low ECMO flows demonstrates sufficient native cardiac output to sustain perfusion.
In neonatal ECMO for meconium aspiration syndrome, the most important criterion indicating readiness to wean is:
Answer: Decreasing oxygen requirement and improving native lung compliance on ventilator
Improved pulmonary compliance and reduced FiO2 requirement on the ventilator indicate recovery of native lung function in neonates.
After VV-ECMO decannulation via the internal jugular vein, the patient develops acute hypoxia with absent breath sounds on the right. The most likely complication is:
Answer: Pneumothorax from inadvertent pleural injury during cannula removal
Pneumothorax is a recognized complication of internal jugular cannula removal, especially if the patient coughs or Valsalvas during the procedure.
During gradual flow reduction in VV-ECMO weaning, which laboratory value should be monitored most closely to detect inadequate native lung CO2 clearance?
Answer: Arterial PaCO2
Rising arterial PaCO2 during sweep reduction signals that native lungs cannot clear CO2 sufficiently to sustain the wean.
A patient being weaned from VA-ECMO develops LV distension confirmed by echo. Before decannulation, the priority intervention is:
Answer: Insert an Impella or intra-aortic balloon pump to unload the LV
LV distension during VA-ECMO unloading failure requires a dedicated LV unloading device (Impella or IABP) to prevent pulmonary edema and myocardial injury.
Which strategy is recommended to minimize the risk of air embolism during percutaneous VV-ECMO decannulation via the femoral vein?
Answer: Place the patient in Trendelenburg position and remove cannula during expiration or Valsalva
Trendelenburg positioning and removal during expiration increases venous pressure at the site, reducing the risk of air entrainment.
After successful decannulation from VA-ECMO, anticoagulation management typically involves:
Answer: Continuation of therapeutic anticoagulation per underlying cardiac condition and thromboembolic risk
Post-decannulation anticoagulation is individualized based on the underlying cardiac pathology, residual thrombus risk, and bleeding status.