IEC ECMO TEST QUESTIONS AND
ANSWERS
What is the normal SVO2 in a healthy adult? - Correct Answers -60-80%
True or False? Chest compressions are warranted during cardiac arrest on a VV ECMO
patient. - Correct Answers -True
Your VA ECMO patient goes into cardiac arrest, showing asystole on the monitor. Do
chest compressions need to be done? - Correct Answers -No
When would it be appropriate to hand crank or switch to a back up drive? - Correct
Answers -Electrical failure and/or mechanical failure
The ECMO heater is set at 38 degrees. The arterial blood temperature is reading 35.5
and the patient is shivering. What are the first two things you should do? - Correct
Answers -Check the heater water level and line patency
You have a 30 year old woman on VA ECMO with severe sepsis. Over the course of a
shift she has had to go from 12 LPM of sweep to 15 LPM. Despite being adequately
sedated and paralyzed her ABGs continue to worsen. The circuit and oxygenator are
working correctly as well. What else can we do to reduce her metabolic demand? -
Correct Answers -Cooling/hypothermia protocol
Of these four choices, which VV cannulation strategy has the least incidence of re-
circulation and allows the highest flows? - Correct Answers -R femoral drain/R internal
jugular return
In which of these patients are rest ventilator settings warranted? - Correct Answers -A
22 year old male with severe bilateral pulmonary contusions on day 3 of VV ECMO
Current ARDSnet guidelines are which of the following? - Correct Answers -pPlat < 30,
Vt = 6 mL/kg of ideal body weight
You have a patient in pressure control ventilation. Which 3 things will increase mean
airway pressure? - Correct Answers -Increase PEEP, I-time, and pressure control
As mean airway pressure increases, preload is more likely to do what? - Correct
Answers -Decrease
, You have a 15 year old boy on VV ECMO. Blood flow is 3.2 LPM, sweep is 2.0 LPM,
and 40% FdO2. The vent is set on volume control with a rate of 14, tidal volume of 500
mL, PEEP of 12, and FiO2 of 40%. The patient has been sedated and is breathing 14
times a minute. His last ABG was 7.40, PCO2 of 40, and PaO2 of 90. We want to trial
him off ECMO for the first time. What vent change should you probably make and why?
- Correct Answers -Increase set RR to 18 to make up for the 2 LPM of sweep we are
about to lose (2 LPM = RR of 4 x 500 mL tidal volume)
Which VA cannulation strategy facilitates the highest flows? - Correct Answers -
Sternotomy with RA drain and aortic return
Left pulmonary artery - Correct Answers -What is number 14 referring to?
Left pulmonary veins - Correct Answers -What is number 16 referring to?
Why do people get pulmonary veins and pulmonary arteries mixed up on heart
diagrams? (explanation card) - Correct Answers -The colors are backwards than what is
typical. Usually veins are blue and arteries are red. With the pulmonary arteries we have
to remember that arteries pump away from the heart and veins pump to the heart.
Because this causes the colors to be reversed...with the pulmonary arteries carrying
"blue" deoxygenated blood to the lungs...then returning "red" oxygenated blood back to
the heart from the lungs through the pulmonary veins. (explanation card)
Which VA cannulation strategy facilitates the fastest cannulation during an eCPR case?
- Correct Answers -Percutaneous, R femoral drain/L femoral return
You have a 32 year old VA ECMO patient, cannulated fem/fem. She's on day 3 and has
had a GI bleed requiring 6 units of PRBCs, 3 FFp, 2 platelets, and 10 units of cryo. She
is up 3.5 liters in 24 hours on her I/O balance. Her respiratory status has declined and
she is requiring 100% on the vent and the pump. Her ECMO flows are at goal cardiac
index for this patient. You draw a blood gas from her right radial arterial line and her
PaO2 is 52 with a SaO2 of 82%. The hour previously these values were a PaO2 of 86
and a SaO2 of 94%. What is going on with this patient and what should be done? -
Correct Answers -Differential hypoxia, consider beta blockers or convert to VAV ECMO
You have a 24 year old ARDS patient on VV ECMO. As you are monitoring the patient,
his heart-rate increases from 105 to 160 bpm, which causes a 45% increase in native
cardiac output. What do you expect would happen to his SpO2 measured on the left
index finger? - Correct Answers -SpO2 would decrease
A 19 year old female patient is on VV ECMO with a femoral drainage cannula and a RIJ
return cannula. Her SpO2 suddenly decreases from 88% to 78%. The ECMO flow and
pressures are unchanged; the circuit SvO2 has increased from 76% to 84%. The
patient's status continues to worsen. What is happening with this patient? - Correct
Answers -Recirculation
ANSWERS
What is the normal SVO2 in a healthy adult? - Correct Answers -60-80%
True or False? Chest compressions are warranted during cardiac arrest on a VV ECMO
patient. - Correct Answers -True
Your VA ECMO patient goes into cardiac arrest, showing asystole on the monitor. Do
chest compressions need to be done? - Correct Answers -No
When would it be appropriate to hand crank or switch to a back up drive? - Correct
Answers -Electrical failure and/or mechanical failure
The ECMO heater is set at 38 degrees. The arterial blood temperature is reading 35.5
and the patient is shivering. What are the first two things you should do? - Correct
Answers -Check the heater water level and line patency
You have a 30 year old woman on VA ECMO with severe sepsis. Over the course of a
shift she has had to go from 12 LPM of sweep to 15 LPM. Despite being adequately
sedated and paralyzed her ABGs continue to worsen. The circuit and oxygenator are
working correctly as well. What else can we do to reduce her metabolic demand? -
Correct Answers -Cooling/hypothermia protocol
Of these four choices, which VV cannulation strategy has the least incidence of re-
circulation and allows the highest flows? - Correct Answers -R femoral drain/R internal
jugular return
In which of these patients are rest ventilator settings warranted? - Correct Answers -A
22 year old male with severe bilateral pulmonary contusions on day 3 of VV ECMO
Current ARDSnet guidelines are which of the following? - Correct Answers -pPlat < 30,
Vt = 6 mL/kg of ideal body weight
You have a patient in pressure control ventilation. Which 3 things will increase mean
airway pressure? - Correct Answers -Increase PEEP, I-time, and pressure control
As mean airway pressure increases, preload is more likely to do what? - Correct
Answers -Decrease
, You have a 15 year old boy on VV ECMO. Blood flow is 3.2 LPM, sweep is 2.0 LPM,
and 40% FdO2. The vent is set on volume control with a rate of 14, tidal volume of 500
mL, PEEP of 12, and FiO2 of 40%. The patient has been sedated and is breathing 14
times a minute. His last ABG was 7.40, PCO2 of 40, and PaO2 of 90. We want to trial
him off ECMO for the first time. What vent change should you probably make and why?
- Correct Answers -Increase set RR to 18 to make up for the 2 LPM of sweep we are
about to lose (2 LPM = RR of 4 x 500 mL tidal volume)
Which VA cannulation strategy facilitates the highest flows? - Correct Answers -
Sternotomy with RA drain and aortic return
Left pulmonary artery - Correct Answers -What is number 14 referring to?
Left pulmonary veins - Correct Answers -What is number 16 referring to?
Why do people get pulmonary veins and pulmonary arteries mixed up on heart
diagrams? (explanation card) - Correct Answers -The colors are backwards than what is
typical. Usually veins are blue and arteries are red. With the pulmonary arteries we have
to remember that arteries pump away from the heart and veins pump to the heart.
Because this causes the colors to be reversed...with the pulmonary arteries carrying
"blue" deoxygenated blood to the lungs...then returning "red" oxygenated blood back to
the heart from the lungs through the pulmonary veins. (explanation card)
Which VA cannulation strategy facilitates the fastest cannulation during an eCPR case?
- Correct Answers -Percutaneous, R femoral drain/L femoral return
You have a 32 year old VA ECMO patient, cannulated fem/fem. She's on day 3 and has
had a GI bleed requiring 6 units of PRBCs, 3 FFp, 2 platelets, and 10 units of cryo. She
is up 3.5 liters in 24 hours on her I/O balance. Her respiratory status has declined and
she is requiring 100% on the vent and the pump. Her ECMO flows are at goal cardiac
index for this patient. You draw a blood gas from her right radial arterial line and her
PaO2 is 52 with a SaO2 of 82%. The hour previously these values were a PaO2 of 86
and a SaO2 of 94%. What is going on with this patient and what should be done? -
Correct Answers -Differential hypoxia, consider beta blockers or convert to VAV ECMO
You have a 24 year old ARDS patient on VV ECMO. As you are monitoring the patient,
his heart-rate increases from 105 to 160 bpm, which causes a 45% increase in native
cardiac output. What do you expect would happen to his SpO2 measured on the left
index finger? - Correct Answers -SpO2 would decrease
A 19 year old female patient is on VV ECMO with a femoral drainage cannula and a RIJ
return cannula. Her SpO2 suddenly decreases from 88% to 78%. The ECMO flow and
pressures are unchanged; the circuit SvO2 has increased from 76% to 84%. The
patient's status continues to worsen. What is happening with this patient? - Correct
Answers -Recirculation
