ECMO ECPR and Special Populations 4

Question 1

Which ECMO configuration is preferred for ECPR in a patient with severe pulmonary hypertension as the cause of cardiac arrest?

Accepted Answer

VA-ECMO via right atrium to pulmonary artery (PA)

Answer

Right atrium to pulmonary artery ECMO directly unloads the right ventricle, which is the failing chamber in severe pulmonary hypertension.

Question 2

In ECPR for pediatric myocarditis, which echocardiographic finding would most support initiating ECMO support?

Accepted Answer

EF < 25% with biventricular dilation

Answer

Severely reduced EF below 25% with biventricular dilation in myocarditis indicates cardiogenic shock unresponsive to conventional therapy, supporting ECMO initiation.

Question 3

When performing ECPR on a patient with a known bleeding disorder (hemophilia A), the anticoagulation strategy should be modified to:

Accepted Answer

Replace UFH with bivalirudin and target lower ACT

Answer

Bivalirudin avoids heparin resistance and allows direct thrombin inhibition while targeting a lower ACT to reduce bleeding risk in coagulopathic patients.

Question 4

What is the primary reason ECPR outcomes in out-of-hospital cardiac arrest (OHCA) are inferior to in-hospital cardiac arrest (IHCA)?

Accepted Answer

Longer no-flow and low-flow times in OHCA

Answer

OHCA results in longer periods of no-flow and low-flow before ECPR initiation, leading to greater ischemic injury compared to IHCA.

Question 5

In a septic patient on VA-ECMO after ECPR, which hemodynamic finding indicates the ECMO is adequately offloading the left ventricle?

Accepted Answer

Non-pulsatile arterial trace with narrow pulse pressure

Answer

A non-pulsatile, narrow pulse-pressure arterial trace indicates the ECMO is providing most of the cardiac output, minimizing LV work.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO ECPR and Special Populations 4