ECMO Complications and Troubleshooting 3

Question 1

During ECMO, the team notices pink frothy fluid in the sweep gas exhaust. What does this indicate?

Accepted Answer

Plasma leak through the oxygenator membrane

Answer

Pink frothy fluid in the sweep gas exhaust indicates plasma leakage across the oxygenator membrane, which can reduce gas exchange efficiency and require oxygenator replacement.

Question 2

A VA-ECMO patient on full support suddenly develops pulsatile arterial waveforms with increased mean arterial pressure. This most likely indicates:

Accepted Answer

Recovery of native cardiac function

Answer

Return of pulsatility on VA-ECMO signifies improved native cardiac contractility, which is a positive sign of cardiac recovery.

Question 3

An ECMO patient develops hemoglobinuria. The initial management step should be to:

Accepted Answer

Increase urine output with fluids and loop diuretics to protect kidneys

Answer

Hemolysis-induced hemoglobinuria can cause acute kidney injury; aggressive diuresis and urine alkalinization help protect renal tubules while the hemolysis source is investigated.

Question 4

Plasma-free hemoglobin (pfHgb) is measured at 800 mg/dL in an ECMO patient. What circuit issue should be investigated first?

Accepted Answer

High pump speed causing cavitation and RBC destruction

Answer

Elevated pfHgb indicates hemolysis, commonly caused by excessive pump speed generating shear stress that destroys red blood cells.

Question 5

A patient on ECMO develops fever to 39.8°C with positive blood cultures for Candida. The most appropriate step regarding the ECMO circuit is:

Accepted Answer

Change the entire ECMO circuit and cannulas

Answer

Fungal bloodstream infections in ECMO patients require circuit and cannula change, as biofilm on surfaces cannot be sterilized with systemic antifungals alone.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Complications and Troubleshooting 3