FREE Foundations of ECMO and ECMO Management Questions and Answers

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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”)?

Correct! Wrong!

Explanation:
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.

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”)?

Correct! Wrong!

Explanation:
No, this patient has end-stage-renal-disease and is on dialysis so this would exclude her from ECPR (refractory arrest, “ECMO Alert”).

Is ECMO the same as cardiac bypass used in open-heart surgeries?

Correct! Wrong!

Explanation:
No, ECMO and bypass are not the same. They have similar functions but are operationally very different.

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?

Correct! Wrong!

Explanation:
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.

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?

Correct! Wrong!

Explanation:
Yes, there is a protocol.

Inclusion Criteria:
- Age 18-75 years old
- Initial shockable rhythm (VF/VT/AED advised shock)
- Witnessed arrest by bystanders or prehospital personnel
- Suspected cardiac cause of arrest
- Body habitus allows LUCAS CPR (must be used for transport)
- FULL CODE

Exclusion Criteria:
- Permanent resident of a skilled nursing facility (i.e. nursing home)
- Known pre-existing organ failures or co-morbidities that would prevent a return to independent living

Is ECPR (refractory arrest, “ECMO Alert”) different than ECMO?

Correct! Wrong!

Explanation:
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”).

What are the risks associated with ECMO?

Correct! Wrong!

Explanation:
There are some concerning risks and downsides associated with ECMO and eCPR:
Bleeding
Trauma to vessels
Needle sticks and exposures to healthcare workers during cannulation
Can be confusing and overwhelming to the patient’s family
Very resource intensive and expensive

But there are benefits as well: Increased neurologically intact survival from cardiac arrest

What does ECMO treat?

Correct! Wrong!

Explanation:
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.

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”)?

Correct! Wrong!

Explanation:
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.

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”)?

Correct! Wrong!

Explanation:
Yes, this patient would be great for ECPR (refractory arrest, “ECMO Alert”).

What are the two most commonly used types of ECMO?

Correct! Wrong!

Explanation:
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.

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