ECMO Cannulation Techniques and Strategies 5

Question 1

What is the most significant risk of advancing the venous drainage cannula too far into the right ventricle during ECMO cannulation?

Accepted Answer

Ventricular arrhythmias and potential perforation

Answer

A cannula tip in the right ventricle can irritate the myocardium, trigger ventricular arrhythmias, and risk perforation of the thin RV wall.

Question 2

During emergent bedside percutaneous ECMO cannulation without fluoroscopy, which bedside imaging tool is considered the standard of care for real-time guidance?

Accepted Answer

Point-of-care ultrasound (POCUS)

Answer

POCUS enables real-time vessel visualization, needle guidance, and cannula tip confirmation at the bedside without radiation or contrast.

Question 3

Which characteristic of a wire-reinforced ECMO cannula reduces the risk of circuit failure?

Accepted Answer

The reinforcement prevents kinking under bending or positional changes

Answer

Wire reinforcement maintains cannula lumen patency under compression or bending, preventing flow interruption from kinking.

Question 4

A patient on femoral VA-ECMO develops sudden loss of ECMO flow with high negative inlet pressures and circuit chattering. After ruling out hypovolemia, the next step is to:

Accepted Answer

Assess for suction events by repositioning or flushing the drainage cannula

Answer

Persistent chattering after correcting volume suggests the drainage cannula is against a vessel wall; repositioning or minor flushing can relieve obstruction.

Question 5

What is the primary advantage of a percutaneous over a surgical cutdown approach for ECMO cannulation in most adults?

Accepted Answer

Faster access, lower bleeding risk at the site, and no surgical wound

Answer

Percutaneous Seldinger-based cannulation is faster in an emergency, avoids a surgical incision, and is associated with lower local complication rates in experienced hands.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Cannulation Techniques and Strategies 5