ECMO Veno-Venous (VV) ECMO Management 4

Question 1

Which factor most reliably predicts the ability to successfully wean a patient from VV ECMO?

Accepted Answer

Maintenance of adequate SpO2 during a spontaneous breathing trial with sweep gas off

Answer

A weaning trial with sweep gas reduced or off tests the native lung's ability to maintain gas exchange independently, which is the best predictor of successful decannulation.

Question 2

What ventilator strategy is recommended for native lung protection during VV ECMO support?

Accepted Answer

Ultra-protective ventilation: low Vt (2–4 mL/kg), low rate, permissive hypercapnia

Answer

ECMO allows ultra-protective ventilation with very low tidal volumes and rates, minimizing ventilator-induced lung injury while the circuit maintains gas exchange.

Question 3

During VV ECMO, a patient develops severe hypokalemia (K+ 2.8 mEq/L). Which factor unique to ECMO contributes to electrolyte depletion?

Accepted Answer

Continuous renal replacement therapy often co-administered

Answer

Many ECMO patients receive concurrent CRRT, which significantly increases electrolyte clearance and requires aggressive electrolyte replacement.

Question 4

A VV ECMO patient has a post-membrane pO2 of 500 mmHg but SvO2 measured from the drainage cannula is only 55%. What does this indicate?

Accepted Answer

High oxygen consumption relative to delivery

Answer

Low drainage cannula SvO2 (which approximates true mixed venous oxygen saturation) indicates high oxygen extraction due to elevated consumption or insufficient delivery.

Question 5

Which intervention is indicated when a VV ECMO patient develops massive intracranial hemorrhage?

Accepted Answer

Discontinue anticoagulation and consider urgent decannulation

Answer

Massive ICH on ECMO requires stopping anticoagulation immediately, and if the hemorrhage is life-threatening, urgent decannulation should be considered despite ECMO dependence.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Veno-Venous (VV) ECMO Management 4