ECMO Weaning and Decannulation 3

Question 1

Which hemodynamic goal during a VA-ECMO weaning trial best predicts successful decannulation?

Accepted Answer

Maintaining MAP > 65 mmHg on low-dose vasopressors with ECMO flow ≤ 1.5 L/min

Answer

Hemodynamic stability with minimal vasopressor support at low ECMO flows demonstrates sufficient native cardiac output to sustain perfusion.

Question 2

In neonatal ECMO for meconium aspiration syndrome, the most important criterion indicating readiness to wean is:

Accepted Answer

Decreasing oxygen requirement and improving native lung compliance on ventilator

Answer

Improved pulmonary compliance and reduced FiO2 requirement on the ventilator indicate recovery of native lung function in neonates.

Question 3

After VV-ECMO decannulation via the internal jugular vein, the patient develops acute hypoxia with absent breath sounds on the right. The most likely complication is:

Accepted Answer

Pneumothorax from inadvertent pleural injury during cannula removal

Answer

Pneumothorax is a recognized complication of internal jugular cannula removal, especially if the patient coughs or Valsalvas during the procedure.

Question 4

During gradual flow reduction in VV-ECMO weaning, which laboratory value should be monitored most closely to detect inadequate native lung CO2 clearance?

Accepted Answer

Arterial PaCO2

Answer

Rising arterial PaCO2 during sweep reduction signals that native lungs cannot clear CO2 sufficiently to sustain the wean.

Question 5

A patient being weaned from VA-ECMO develops LV distension confirmed by echo. Before decannulation, the priority intervention is:

Accepted Answer

Insert an Impella or intra-aortic balloon pump to unload the LV

Answer

LV distension during VA-ECMO unloading failure requires a dedicated LV unloading device (Impella or IABP) to prevent pulmonary edema and myocardial injury.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Weaning and Decannulation 3