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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.

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  1. In pediatric VA-ECMO for post-cardiac surgery myocardial stunning, which myocardial function marker on echocardiography is most commonly used to guide weaning readiness?

    Answer: Left ventricular shortening fraction > 25–30%

    An LV shortening fraction above 25–30% on echocardiography is a widely used pediatric benchmark indicating adequate myocardial recovery for VA-ECMO weaning.

  2. During a VV-ECMO weaning trial with sweep gas at zero, the patient's arterial blood gas shows pH 7.30, PaCO2 58 mmHg, PaO2 72 mmHg on FiO2 0.50. The correct interpretation is:

    Answer: Oxygenation is marginal and CO2 retention is unacceptable; defer decannulation

    Both significant hypercapnia (PaCO2 58) and borderline oxygenation with respiratory acidosis indicate the native lungs are not yet ready to sustain gas exchange independently.

  3. Which of the following correctly describes the 'bridge-to-decision' scenario in which ECMO decannulation is deferred pending further evaluation?

    Answer: ECMO supports a patient awaiting heart transplant listing or durable LVAD implantation

    Bridge-to-decision ECMO maintains perfusion while the team evaluates candidacy for definitive therapy such as transplant or durable mechanical support.

  4. When performing surgical decannulation of an arterial cannula in the femoral artery, the surgeon should routinely assess for:

    Answer: Distal limb perfusion by checking pedal pulses or Doppler signals after repair

    Arterial decannulation carries risk of distal ischemia or embolism; confirming pedal pulses or Doppler flow after repair is essential before closure.

  5. A patient fails multiple VA-ECMO weaning trials over 14 days. The ECMO team should next consider:

    Answer: Evaluation for durable ventricular assist device implantation or heart transplantation

    Repeated weaning failure after 2 weeks indicates the heart is unlikely to recover; escalation to a durable VAD or transplant evaluation is the appropriate next step.

  6. During decannulation of a right internal jugular VV-ECMO cannula, which maneuver most effectively prevents venous air embolism at the moment of cannula withdrawal?

    Answer: Asking the patient to perform a Valsalva maneuver or holding breath at end-expiration

    Valsalva or breath-hold at end-expiration raises intrathoracic and central venous pressure, preventing air from entering the vein during cannula withdrawal.

  7. In ECMO weaning protocols, 'flow titration' refers to:

    Answer: Systematically reducing pump blood flow in incremental steps while monitoring hemodynamic and gas exchange response

    Flow titration involves stepping down pump flow incrementally (e.g., 0.5 L/min decrements) to stress-test the patient's native cardiopulmonary function before decannulation.