ECMO SPECIALIST EXAM
QUESTIONS AND ANSWERS
How to recognize cardiogenic shock? (acronym) - Correct Answers -CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) - Correct Answers -(ECLS )
ECG
Consult- surgeon
Labs- lactates, abgs etc.
Swan catheter
what is PAPI score? Formula and normal value - Correct Answers -differentiates
between the LV/RV disfunction, if low = RV dysfunction
PAPi= (sPAP-dPAP)/RA
it is the pa sys - the pa dyastolic / right atrial pressure- can get these numbers from
swan
normal is >1.0
Formula for cardiac power output (CPO) and normal value - Correct Answers -CPO=
MAP x CO/451
normal = 0.7 to 1 W
what are the three key measurements for cardiogenic shock? - Correct Answers -PAPI
CPO
Lactate
what is cardiac power output? - Correct Answers -amount of energy available to
maintain the perfusion of the vital organs in shock
what does lactate in the blood mean and normal value? - Correct Answers -anerobic
metabolism is occurring
, normal is 0.9 to 1.7
what are the two goals of mechanical circulatory support? - Correct Answers -restore
adequate end organ perfusion
ventricular unloading
how does the impella CP work as an LV vent? - Correct Answers -drains at LV and
returns at the aortic arch
provides 3-3.5 LPM of flow
what are the 5 factors affecting pharmacokinetics with critical illness? - Correct Answers
-1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? - Correct Answers -the bodys biological response to the
drug
what are the factors 5 affecting pharmacokinetics with ECMO? - Correct Answers -1.
augmented cardiac output
2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
which drugs should you avoid with ecmo? - Correct Answers -benzos!!! lipophillic and
sequester in the tubing
why do we need anticoagulation on ecmo? - Correct Answers -blood contacts the ecmo
circuit causing a sirs response and leads to:
inflammation/vasodilation
coagulation
altered fibrinolysis
how does heparin work? - Correct Answers -Activates antithrombin III -> inactivates
thrombin, factor IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? - Correct Answers -1. Mild-
pf ratio is 200-300 mmhg w/peep or CPAP > 5
2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
3. severe- pf ratio is <100 mmhg with peep > 5
QUESTIONS AND ANSWERS
How to recognize cardiogenic shock? (acronym) - Correct Answers -CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) - Correct Answers -(ECLS )
ECG
Consult- surgeon
Labs- lactates, abgs etc.
Swan catheter
what is PAPI score? Formula and normal value - Correct Answers -differentiates
between the LV/RV disfunction, if low = RV dysfunction
PAPi= (sPAP-dPAP)/RA
it is the pa sys - the pa dyastolic / right atrial pressure- can get these numbers from
swan
normal is >1.0
Formula for cardiac power output (CPO) and normal value - Correct Answers -CPO=
MAP x CO/451
normal = 0.7 to 1 W
what are the three key measurements for cardiogenic shock? - Correct Answers -PAPI
CPO
Lactate
what is cardiac power output? - Correct Answers -amount of energy available to
maintain the perfusion of the vital organs in shock
what does lactate in the blood mean and normal value? - Correct Answers -anerobic
metabolism is occurring
, normal is 0.9 to 1.7
what are the two goals of mechanical circulatory support? - Correct Answers -restore
adequate end organ perfusion
ventricular unloading
how does the impella CP work as an LV vent? - Correct Answers -drains at LV and
returns at the aortic arch
provides 3-3.5 LPM of flow
what are the 5 factors affecting pharmacokinetics with critical illness? - Correct Answers
-1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? - Correct Answers -the bodys biological response to the
drug
what are the factors 5 affecting pharmacokinetics with ECMO? - Correct Answers -1.
augmented cardiac output
2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
which drugs should you avoid with ecmo? - Correct Answers -benzos!!! lipophillic and
sequester in the tubing
why do we need anticoagulation on ecmo? - Correct Answers -blood contacts the ecmo
circuit causing a sirs response and leads to:
inflammation/vasodilation
coagulation
altered fibrinolysis
how does heparin work? - Correct Answers -Activates antithrombin III -> inactivates
thrombin, factor IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? - Correct Answers -1. Mild-
pf ratio is 200-300 mmhg w/peep or CPAP > 5
2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
3. severe- pf ratio is <100 mmhg with peep > 5
