ECMO Foundations of ECMO and ECMO Management 4

Question 1

A centrifugal pump used in modern ECMO circuits generates flow primarily through:

Accepted Answer

Impeller or cone rotation creating centrifugal force

Answer

Centrifugal ECMO pumps use a rapidly spinning impeller or cone that imparts kinetic energy to blood through centrifugal force, generating flow.

Question 2

When ECMO pump RPM is increased but flow does not increase proportionally, the most likely cause is:

Accepted Answer

Pump head thrombosis or increased circuit resistance

Answer

Increased RPM without proportional flow increase suggests elevated circuit resistance, often from clot formation in the pump head or oxygenator.

Question 3

In neonatal ECMO for meconium aspiration syndrome, which mode is typically preferred as first-line?

Accepted Answer

VA-ECMO via carotid artery and jugular vein

Answer

Neonatal VA-ECMO via the right common carotid artery and right internal jugular vein is the standard approach because neonatal vessels are too small for suitable VV-ECMO cannulas.

Question 4

The primary purpose of a 'lung rest' strategy during VV-ECMO for severe ARDS is to:

Accepted Answer

Apply ultra-protective ventilation settings to minimize ventilator-induced lung injury

Answer

Lung rest on VV-ECMO allows extreme reduction in mechanical ventilation parameters (low tidal volumes, low pressures, low rates) to minimize ongoing ventilator-induced lung injury.

Question 5

Left ventricular distension (LV dilation) during VA-ECMO is most commonly managed by:

Accepted Answer

LV venting via an Impella device or atrial septostomy

Answer

LV venting with an Impella or atrial septostomy decompresses the distended LV, reduces wall stress, and may improve myocardial recovery.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Foundations of ECMO and ECMO Management 4