ECMO Weaning and Decannulation 5

Question 1

Which combination of ventilator settings during a VV-ECMO weaning trial most closely mimics conditions the patient will face after decannulation?

Accepted Answer

Protective lung settings (FiO2 ≤ 0.40, PEEP 8–10 cmH2O) with sweep gas off

Answer

Protective ventilation at low FiO2 with sweep off simulates post-decannulation conditions, revealing whether the lungs can sustain gas exchange independently.

Question 2

A previously anticoagulated ECMO patient requires decannulation but has an INR of 3.2 and platelet count of 45,000/µL. What is the most appropriate preparatory step?

Accepted Answer

Correct coagulopathy with fresh frozen plasma and platelets before decannulation, targeting INR < 1.5 and platelets > 80,000/µL

Answer

Correcting coagulopathy before decannulation reduces the risk of life-threatening hemorrhage at cannula removal sites.

Question 3

Which clinical sign during a VA-ECMO low-flow weaning trial indicates right ventricular failure and should prompt aborting the trial?

Accepted Answer

Rising central venous pressure with hepatomegaly and worsening systemic hypotension

Answer

Elevated CVP with hepatomegaly and systemic hypotension during flow reduction signals right ventricular failure, mandating return to full ECMO support.

Question 4

In the context of ECMO weaning, what does the term 'circuit holiday' refer to?

Accepted Answer

A brief period of complete ECMO flow cessation (with circuit clamping) to assess native cardiopulmonary function

Answer

A circuit holiday (clamp trial) briefly stops all ECMO flow with the circuit clamped to evaluate whether native heart and lung function can sustain the patient.

Question 5

Following decannulation from femoral VA-ECMO, a patient develops ipsilateral leg swelling and pain. Duplex ultrasound reveals deep vein thrombosis at the cannulation site. Appropriate management includes:

Accepted Answer

Therapeutic anticoagulation and monitoring for pulmonary embolism

Answer

Cannulation-site DVT is managed with therapeutic anticoagulation and surveillance for PE, similar to other lower-extremity DVT.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Weaning and Decannulation 5