FREE Foundations of ECMO and ECMO Management Questions and Answers

Question 1

What does ECMO treat?

Accepted Answer

ECMO is a temporary support system while the underlying issue is addressed

Answer

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.

Question 2

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

Accepted Answer

No, ECPR is the same as ECMO.

Answer

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”).

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?

Accepted Answer

No, this patient is not a good candidate for eCPR due to age and residing in a nursing home.

Answer

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.

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?

Accepted Answer

Yes, there is a protocol that includes age, initial rhythm, and arrest witnessed criteria.

Answer

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

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”)?

Accepted Answer

No, because he achieved ROSC before transport.

Answer

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.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

FREE Foundations of ECMO and ECMO Management Questions and Answers