Weaning and Decannulation Flashcards

Which combination of ventilator settings during a VV-ECMO weaning trial most closely mimics conditions the patient will face after decannulation?

Answer: Protective lung settings (FiO2 ≤ 0.40, PEEP 8–10 cmH2O) with sweep gas off

Protective ventilation at low FiO2 with sweep off simulates post-decannulation conditions, revealing whether the lungs can sustain gas exchange independently.

A previously anticoagulated ECMO patient requires decannulation but has an INR of 3.2 and platelet count of 45,000/µL. What is the most appropriate preparatory step?

Answer: Correct coagulopathy with fresh frozen plasma and platelets before decannulation, targeting INR 80,000/µL

Correcting coagulopathy before decannulation reduces the risk of life-threatening hemorrhage at cannula removal sites.

Which clinical sign during a VA-ECMO low-flow weaning trial indicates right ventricular failure and should prompt aborting the trial?

Answer: Rising central venous pressure with hepatomegaly and worsening systemic hypotension

Elevated CVP with hepatomegaly and systemic hypotension during flow reduction signals right ventricular failure, mandating return to full ECMO support.

In the context of ECMO weaning, what does the term 'circuit holiday' refer to?

Answer: A brief period of complete ECMO flow cessation (with circuit clamping) to assess native cardiopulmonary function

A circuit holiday (clamp trial) briefly stops all ECMO flow with the circuit clamped to evaluate whether native heart and lung function can sustain the patient.

Following decannulation from femoral VA-ECMO, a patient develops ipsilateral leg swelling and pain. Duplex ultrasound reveals deep vein thrombosis at the cannulation site. Appropriate management includes:

Answer: Therapeutic anticoagulation and monitoring for pulmonary embolism

Cannulation-site DVT is managed with therapeutic anticoagulation and surveillance for PE, similar to other lower-extremity DVT.

After decannulation from VV-ECMO, the patient develops hoarseness and difficulty swallowing. The most likely etiology related to the ECMO procedure is:

Answer: Recurrent laryngeal nerve injury or vocal cord dysfunction related to right internal jugular cannulation

The recurrent laryngeal nerve passes near the right internal jugular vein and can be injured during cannulation or decannulation, causing hoarseness.

Which statement correctly describes the role of intra-aortic balloon pump (IABP) in VA-ECMO weaning?

Answer: IABP provides additional LV unloading and hemodynamic support to facilitate ECMO weaning in borderline candidates

IABP augments diastolic coronary perfusion and reduces LV afterload, serving as a bridge device to facilitate VA-ECMO weaning in patients with marginal ventricular recovery.