MANAGEMENT OF ADULT PATIENTS ON
ECMO EXAM QUESTIONS AND ANSWERS
Definition of ECMO - Correct Answers -Extracorporeal membrane oxygenation is the
use of a cardiopulmonary bypass circuit for temporary life support for patients with
potentially reversible cardiac and/or respiratory failure
What does extracorporeal mean? - Correct Answers -Outside of the body
What is Membrane oxygenation? - Correct Answers -Oxygenator is a piece of
equipment that acts as the lungs
ECMO - Correct Answers -functions similar to cardiothoracic bypass machine, except
ECMO is used long term
ECMO circuit - Correct Answers -artificial lungs and heart for the patient
How does ECMO work? - Correct Answers -Venous blood drained from the patient
●Oxygenator removes CO2 and adds O2
●Blood is heated to body temperature
●Pump returns oxygenated blood back to the patient
Veno-Arterial VA ECMO - Correct Answers -Bypass heart and lungs
●Allows gas exchange and hemodynamic support while blood is pumped from the
venous to the arterial side
Veno-Venous (VV ECMO) - Correct Answers -●Bypass lungs
●Facilitates gas exchange; blood is removed from the venous side and then pumped
back into it, but does not provide hemodynamic support
VA ECMO - Correct Answers -●Higher PaO2 is achieved
●Lower perfusion rates are needed
●Bypass pulmonary circulation
●Decreases pulmonary artery pressures
●Provides cardiac support to assist systemic circulation
●Requires arterial cannulation
VV ECMO - Correct Answers -Lower PaO2 is achieved
●Higher perfusion rates are needed
●Maintains pulmonary blood flow
, ●Elevates mixed venous PO2
●Does not provide cardiac support to assist systemic circulation
●Requires only venous cannulation
Indication for VA ECMO - Correct Answers -Refractory cardiogenic shock
●Cardiopulmonary arrest
●Failure to wean from cardiopulmonary bypass after cardiac surgery
●As a bridge to placement of a left ventricular assist device (LVAD) or heart transplant
Indications for VV ECMO - Correct Answers -Hypoxemic respiratory failure with a P/F
ratio < 100 mmHg despite optimal ventilator settings (i.e. FiO2
of 100%, PEEP 12, etc.)
●Hypercapnic respiratory failure with an arterial pH
< 7.20
●Pulmonary embolism not affecting cardiac function
●Pneumonia
●Murray score of 3 or greater
Points of convergence are the most accurate determination of - Correct Answers -GAS
EXCHANGE
What does point of convergence indicate - Correct Answers -indicates where your
arterial line should be placed and SpO2 measurement should be recorded
North-South Syndrome or Hypoxic Harlequin Syndrome - Correct Answers -Patient's
head appears blue while lower extremities are pink
Absolute Contraindications - Correct Answers -Any condition that precludes the use of
anticoagulation therapy (uncontrolled active bleeding)
Relative Contraindications - Correct Answers -High-pressure ventilation (end-inspiratory
pressure of > 30 cm H2O) for > 7 days
● High FiO2 requirements (>0.8) for > 7 days
● Limited vascular access
● Any condition or organ dysfunction that would limit the likelihood of overall benefit
from ECMO, such as severe, irreversible brain injury or untreatable
What is the purpose of ECMO? - Correct Answers -therapy is to allow the lungs to rest
and heal
Ventilation Strategy - Correct Answers -Initial therapy is "Dead-space" ventilation (lungs
act as trap for air)
●A "lung protective" strategy is preferred with lower tidal volumes and increased PEEP
●Open lungs and keep them open with minimal
ECMO EXAM QUESTIONS AND ANSWERS
Definition of ECMO - Correct Answers -Extracorporeal membrane oxygenation is the
use of a cardiopulmonary bypass circuit for temporary life support for patients with
potentially reversible cardiac and/or respiratory failure
What does extracorporeal mean? - Correct Answers -Outside of the body
What is Membrane oxygenation? - Correct Answers -Oxygenator is a piece of
equipment that acts as the lungs
ECMO - Correct Answers -functions similar to cardiothoracic bypass machine, except
ECMO is used long term
ECMO circuit - Correct Answers -artificial lungs and heart for the patient
How does ECMO work? - Correct Answers -Venous blood drained from the patient
●Oxygenator removes CO2 and adds O2
●Blood is heated to body temperature
●Pump returns oxygenated blood back to the patient
Veno-Arterial VA ECMO - Correct Answers -Bypass heart and lungs
●Allows gas exchange and hemodynamic support while blood is pumped from the
venous to the arterial side
Veno-Venous (VV ECMO) - Correct Answers -●Bypass lungs
●Facilitates gas exchange; blood is removed from the venous side and then pumped
back into it, but does not provide hemodynamic support
VA ECMO - Correct Answers -●Higher PaO2 is achieved
●Lower perfusion rates are needed
●Bypass pulmonary circulation
●Decreases pulmonary artery pressures
●Provides cardiac support to assist systemic circulation
●Requires arterial cannulation
VV ECMO - Correct Answers -Lower PaO2 is achieved
●Higher perfusion rates are needed
●Maintains pulmonary blood flow
, ●Elevates mixed venous PO2
●Does not provide cardiac support to assist systemic circulation
●Requires only venous cannulation
Indication for VA ECMO - Correct Answers -Refractory cardiogenic shock
●Cardiopulmonary arrest
●Failure to wean from cardiopulmonary bypass after cardiac surgery
●As a bridge to placement of a left ventricular assist device (LVAD) or heart transplant
Indications for VV ECMO - Correct Answers -Hypoxemic respiratory failure with a P/F
ratio < 100 mmHg despite optimal ventilator settings (i.e. FiO2
of 100%, PEEP 12, etc.)
●Hypercapnic respiratory failure with an arterial pH
< 7.20
●Pulmonary embolism not affecting cardiac function
●Pneumonia
●Murray score of 3 or greater
Points of convergence are the most accurate determination of - Correct Answers -GAS
EXCHANGE
What does point of convergence indicate - Correct Answers -indicates where your
arterial line should be placed and SpO2 measurement should be recorded
North-South Syndrome or Hypoxic Harlequin Syndrome - Correct Answers -Patient's
head appears blue while lower extremities are pink
Absolute Contraindications - Correct Answers -Any condition that precludes the use of
anticoagulation therapy (uncontrolled active bleeding)
Relative Contraindications - Correct Answers -High-pressure ventilation (end-inspiratory
pressure of > 30 cm H2O) for > 7 days
● High FiO2 requirements (>0.8) for > 7 days
● Limited vascular access
● Any condition or organ dysfunction that would limit the likelihood of overall benefit
from ECMO, such as severe, irreversible brain injury or untreatable
What is the purpose of ECMO? - Correct Answers -therapy is to allow the lungs to rest
and heal
Ventilation Strategy - Correct Answers -Initial therapy is "Dead-space" ventilation (lungs
act as trap for air)
●A "lung protective" strategy is preferred with lower tidal volumes and increased PEEP
●Open lungs and keep them open with minimal
