ECMO ECPR and Special Populations 5

Question 1

Which neonatal cardiac diagnosis most commonly requires ECMO support in the immediate post-operative period?

Accepted Answer

Hypoplastic left heart syndrome (HLHS) after Norwood procedure

Answer

HLHS after Norwood palliation carries the highest rate of post-operative ECMO requirement due to single-ventricle physiology and complex hemodynamics.

Question 2

A trauma patient on ECPR after traumatic cardiac arrest has ongoing abdominal hemorrhage. The most appropriate anticoagulation management is:

Accepted Answer

Heparin-free ECMO circuit with careful monitoring

Answer

Heparin-free or minimally heparinized ECMO is used in active hemorrhage to balance circuit thrombosis risk against life-threatening bleeding.

Question 3

During ECPR for a patient in status asthmaticus cardiac arrest, which ventilator strategy is most appropriate once on ECMO?

Accepted Answer

Permissive hypercapnia with prolonged expiratory time and low PEEP

Answer

Status asthmaticus requires permissive hypercapnia, very low respiratory rates, and prolonged expiratory time to prevent dynamic hyperinflation; ECMO manages gas exchange.

Question 4

In ECPR for a patient with pulmonary embolism (PE), which additional therapeutic intervention has the strongest evidence as an adjunct to ECMO?

Accepted Answer

Catheter-directed thrombolysis or surgical embolectomy

Answer

Surgical embolectomy or catheter-directed intervention definitively removes the clot burden and is preferred in massive PE on ECMO to restore right ventricular function.

Question 5

What is the recommended activated clotting time (ACT) target range for ECPR in a pediatric patient without active bleeding?

Accepted Answer

160–200 seconds

Answer

ACT targets of 160–200 seconds balance circuit thrombosis prevention with bleeding risk in pediatric ECMO patients without active hemorrhage.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO ECPR and Special Populations 5