Free Foundations of ECMO and ECMO Management Questions and Answers — Questions and Answers
Question 1: What does ECMO treat?
- ECMO treats specific cardiac conditions directly
- ECMO is a temporary support system while the underlying issue is addressed (Correct answer)
- ECMO treats respiratory diseases exclusively
- ECMO is a permanent solution for severe heart failure
Correct answer: ECMO is a temporary support system while the underlying issue is addressed
Explanation: <br> ECMO does not actually “treat” anything. ECMO is used as a bridge to fix the actual problem. ECMO buys you time to figure out what is killing your patient. In some cases, it buys the patient time to heal. Sometimes, our patient’s lungs just need a break. For example, when used during refractory V-fib arrest treatment, it allows us to support the patient and oxygenate the brain while we take the patient to the cath lab to hopefully unblock one of the coronary arteries. It acts as a bridge and buys more time to solve the problem.
Question 2: Is ECPR (refractory arrest, “ECMO Alert”) different than ECMO?
- Yes, ECPR is a different technique than ECMO.
- No, ECPR is the same as ECMO. (Correct answer)
- ECPR is used for lung pathologies, while ECMO is for cardiac arrest.
- ECPR is used for cardiac arrest, while ECMO is for lung pathologies.
Correct answer: No, ECPR is the same as ECMO.
Explanation: <br> No, ECPR (refractory arrest, “ECMO Alert”) is ECMO. Specifically, ECMO is used when someone is in cardiac arrest. Other uses of ECMO do not require the patient to be in cardiac arrest, such as profound lung pathology. ECMO is just the tool used in ECPR (refractory arrest, “ECMO Alert”).
Question 3: You respond to a call at a nursing home for an unresponsive 88-year-old male. When you arrive, you are unable to palpate a pulse. While you are preparing to start chest compression, your partner places the patient on the monitor. When you perform a rhythm check, you notice ventricular fibrillation. After giving epinephrine and defibrillations, you start transporting to the nearest hospital. Is this patient a good candidate for eCPR?
- Yes, this patient is a good candidate for eCPR.
- No, this patient is not a good candidate for eCPR due to the presence of ventricular fibrillation.
- Yes, this patient is a good candidate for eCPR due to the administration of epinephrine.
- No, this patient is not a good candidate for eCPR due to age and residing in a nursing home. (Correct answer)
Correct answer: No, this patient is not a good candidate for eCPR due to age and residing in a nursing home.
Explanation: <br> No, this patient would not be a good candidate for ECPR (refractory arrest, “ECMO Alert”). The patient is excluded due to age and residing in a nursing home. As a reference, ECMO for any indication is not recommended for patients older than 75 years old.
Question 4: Is there a prehospital protocol for ECPR (refractory arrest, “ECMO Alert”) activation when I am taking a patient to one of the hospitals with an ECPR program?
- No, there is no prehospital protocol for ECPR activation.
- Yes, there is a protocol that includes age, initial rhythm, and arrest witnessed criteria. (Correct answer)
- Yes, there is a protocol that includes body habitus and full code status.
- No, there is no protocol specifically for patients transported to hospitals with an ECPR program.
Correct answer: Yes, there is a protocol that includes age, initial rhythm, and arrest witnessed criteria.
Explanation: <br> Yes, there is a protocol. <br> <br> Inclusion Criteria: <br> - Age 18-75 years old <br> - Initial shockable rhythm (VF/VT/AED advised shock) <br> - Witnessed arrest by bystanders or prehospital personnel <br> - Suspected cardiac cause of arrest <br> - Body habitus allows LUCAS CPR (must be used for transport) <br> - FULL CODE <br> <br> Exclusion Criteria: <br> - Permanent resident of a skilled nursing facility (i.e. nursing home) <br> - Known pre-existing organ failures or co-morbidities that would prevent a return to independent living
Question 5: You respond to a call at a lakefront beach for an unresponsive 28-year-old male. When you arrive, you are unable to palpate a pulse. The patient’s friends tell you he was enjoying some alcoholic beverages and was under the water for a long time. His friends pulled him to the shore. You direct your partner to start chest compression while you place an IO. Your friendly neighborhood firefighter places a king airway and starts bagging the patient. You perform a pulse check and notice a good pulse. You and your partner start transporting to the hospital. Is this patient a good candidate for ECPR (refractory arrest, “ECMO Alert”)?
- Yes, because he was submerged for a long time.
- No, because he achieved ROSC before transport. (Correct answer)
- Yes, because drowning patients always require ECPR.
- No, because he does not meet the age criteria for ECPR.
Correct answer: No, because he achieved ROSC before transport.
Explanation: <br> No. You have already achieved ROSC. This patient may ultimately be placed on ECMO, but to support his lungs after drowning. A few days after drowning, patients can have worsening lungs and may be placed on VV ECMO. If he were to lose pulses again, then you can consider ECPR (refractory arrest, “ECMO Alert”) as he does not have any exclusion criteria.
Question 6: You respond to a call at a marathon for a 38-year-old male who collapsed at mile 14. When you arrive, you are unable to palpate a pulse. While you are preparing to start chest compression, your partner places the patient on the monitor. When you perform a rhythm check, you notice ventricular fibrillation. After giving epinephrine and defibrillations, you start transporting to the nearest hospital. Is this patient a good candidate for ECPR (refractory arrest, “ECMO Alert”)?
- Yes, because he collapsed during a marathon.
- No, because he does not meet the age criteria for ECPR.
- Yes, because he was in ventricular fibrillation. (Correct answer)
- No, because he achieved ROSC before transport.
Correct answer: Yes, because he was in ventricular fibrillation.
Explanation: <br> Yes, this patient would be great for ECPR (refractory arrest, “ECMO Alert”).
Question 7: You respond to a call at a dialysis center for an unresponsive 75-year-old female. They collapsed just before starting their dialysis run for the day. When you arrive, you are unable to palpate a pulse. While you are preparing to start chest compression, your partner places the patient on the monitor. When you perform a rhythm check, you notice ventricular fibrillation. After giving epinephrine and defibrillations, you start transporting to the nearest hospital. Is this patient a good candidate for ECPR (refractory arrest, “ECMO Alert”)?
- Yes, because she was in ventricular fibrillation.
- No, because she is too old for ECPR.
- Yes, because she collapsed just prior to dialysis.
- No, because she has end-stage renal disease and is on dialysis. (Correct answer)
Correct answer: No, because she has end-stage renal disease and is on dialysis.
Explanation: <br> No, this patient has end-stage-renal-disease and is on dialysis so this would exclude her from ECPR (refractory arrest, “ECMO Alert”).
Question 8: Is ECMO the same as cardiac bypass used in open-heart surgeries?
- Yes, ECMO and cardiac bypass are the same.
- No, ECMO and cardiac bypass are not the same. (Correct answer)
- ECMO is a type of cardiac bypass used in open-heart surgeries.
- ECMO and cardiac bypass have similar functions but different operational methods.
Correct answer: No, ECMO and cardiac bypass are not the same.
Explanation: <br> No, ECMO and bypass are not the same. They have similar functions but are operationally very different.
Question 9: What are the risks associated with ECMO?
- Bleeding is the only risk associated with ECMO.
- There are no risks associated with ECMO.
- ECMO is not resource-intensive or expensive.
- Bleeding, trauma to vessels, needle sticks, and resource intensity are risks associated with ECMO. (Correct answer)
Correct answer: Bleeding, trauma to vessels, needle sticks, and resource intensity are risks associated with ECMO.
Explanation: <br> There are some concerning risks and downsides associated with ECMO and eCPR: <br> Bleeding <br> Trauma to vessels <br> Needle sticks and exposures to healthcare workers during cannulation <br> Can be confusing and overwhelming to the patient’s family <br> Very resource intensive and expensive <br><br> But there are benefits as well: Increased neurologically intact survival from cardiac arrest
Question 10: You respond to a call at a first-floor apartment for an unresponsive 58-year-old female. Her son was sitting next to her when she became unresponsive and started CPR. When you arrive, you are unable to palpate a pulse. While you are preparing to start chest compression, your partner places the patient on the monitor. When you perform a rhythm check, you notice ventricular fibrillation. After giving epinephrine and defibrillations, you start transporting to the hospital. Based on what you know, is this patient a good candidate for ECPR (refractory arrest, “ECMO Alert”)?
- No, because the patient is unresponsive.
- Yes, because the patient's son initiated CPR.
- No, because the patient's age is outside the acceptable range.
- Yes, because the patient's arrest was witnessed and CPR was initiated promptly. (Correct answer)
Correct answer: Yes, because the patient's arrest was witnessed and CPR was initiated promptly.
Explanation: <br> Yes, this patient does not have any obvious exclusion criteria. Her arrest was witnessed, bystander CPR was started and she fits into the age range.
Question 11: What are the two most commonly used types of ECMO?
- Arterial-arterial (AA) ECMO and Venous-venous (VV) ECMO
- Veno-venous (VV) ECMO and Veno-arterial (VA) ECMO (Correct answer)
- Pulmonary artery (PA) ECMO and Aortic artery (AA) ECMO
- Venous-arterial (VA) ECMO and Arterial-venous (AV) ECMO
Correct answer: Veno-venous (VV) ECMO and Veno-arterial (VA) ECMO
Explanation: <br> Veno-venous (VV) ECMO and Veno-arterial (VA) ECMO. VV ECMO is used to replace the lungs but still uses the heart as a pump for the blood. VA ECMO replaces both the heart and the lungs and ECMO works as the pump.
Free Foundations of ECMO and ECMO Management Questions and Answers
What does ECMO treat?