ECMO Complications and Troubleshooting 5

Question 1

During VA-ECMO weaning, pump speed is reduced to minimum and the patient's mean arterial pressure drops to 50 mmHg with a CVP of 22 mmHg. This hemodynamic pattern suggests:

Accepted Answer

Inability to tolerate reduced ECMO support indicating failed wean

Answer

Hypotension with elevated CVP during ECMO wean indicates the native heart cannot maintain adequate output independently, meaning the patient has failed the wean trial.

Question 2

Air is detected in the ECMO circuit approaching the patient. The immediate response is to:

Accepted Answer

Clamp the arterial limb and stop the pump immediately

Answer

Clamping the arterial limb and stopping the pump immediately prevents air from entering the patient's circulation and causing a fatal air embolism.

Question 3

A patient on ECMO develops a new right pleural effusion with progressive respiratory failure. The most appropriate diagnostic step is:

Accepted Answer

Thoracentesis with fluid sent for analysis including triglycerides

Answer

Thoracentesis both diagnoses and treats the effusion; triglyceride analysis helps identify chylothorax, a recognized ECMO complication from superior vena cava or thoracic duct involvement.

Question 4

A patient on ECMO receiving unfractionated heparin has an aPTT of 220 seconds. The appropriate intervention is:

Accepted Answer

Hold heparin infusion and recheck aPTT in 2 hours

Answer

A supratherapeutic aPTT of 220 seconds greatly increases bleeding risk; holding the heparin infusion temporarily allows levels to fall while avoiding full reversal that risks circuit thrombosis.

Question 5

A patient on neonatal ECMO has persistently low circuit flows despite normal volume status and cannula position. Inspection shows the tubing is not kinked. The next consideration is:

Accepted Answer

Patient has outgrown the cannula size, requiring upsizing

Answer

Growing neonates can outpace the flow capacity of their original cannula size, necessitating cannula exchange to achieve adequate ECMO support.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Complications and Troubleshooting 5