ECMO Veno-Arterial (VA) ECMO Management 5

Question 1

Which pharmacological agent is most commonly used to reduce LV afterload and facilitate LV ejection in VA ECMO patients?

Accepted Answer

Nitroprusside or milrinone

Answer

Vasodilators like nitroprusside or inodilators like milrinone reduce systemic vascular resistance, helping the LV eject against the increased afterload imposed by VA ECMO.

Question 2

When should anticoagulation be withheld or minimized during VA ECMO?

Accepted Answer

In the presence of active life-threatening hemorrhage

Answer

Active life-threatening hemorrhage may require temporarily reducing or withholding anticoagulation despite the risk of circuit thrombosis.

Question 3

Which factor most directly determines the maximum blood flow achievable in a VA ECMO circuit?

Accepted Answer

Venous cannula size and venous drainage

Answer

Venous drainage is the limiting factor in ECMO flow; the venous cannula size and position determine how much blood can be returned to the pump.

Question 4

In post-cardiotomy cardiogenic shock, VA ECMO is initiated. After 72 hours, there is no evidence of cardiac recovery. What is the next appropriate step?

Accepted Answer

Evaluate for advanced therapies: LVAD or cardiac transplantation

Answer

Absence of cardiac recovery at 72–96 hours should prompt evaluation for durable mechanical circulatory support (LVAD) or cardiac transplantation as bridge therapies.

Question 5

What is the effect of increasing ECMO pump speed (RPM) in a patient with severe aortic regurgitation on VA ECMO?

Accepted Answer

It worsens LV distension by increasing retrograde regurgitant volume

Answer

In severe aortic regurgitation, higher ECMO flow increases retrograde pressure in the aortic root, worsening the degree of regurgitation and LV volume overload.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Veno-Arterial (VA) ECMO Management 5