ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Page 1 | Passing Score: 75%
ECMO CERTIFICATION BOARD
ECMO SPECIALIST EXAM 101 QUESTIONS
WITH COMPLETE SOLUTIONS!! 2026/2027
ECMO SPECIALIST · Official Exam 2026/2027
101 75% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 ECMO Physiology & Fundamentals Q1-Q21
Section 2 ECMO Circuit & Equipment Management Q22-Q42
Section 3 Patient Management on ECMO Q43-Q63
Section 4 ECMO Complications & Emergencies Q64-Q84
Section 5 Quality, Safety & Professional Practice Q85-Q101
Instructions: Select the single best answer for each question. This exam is designed for ECMO Specialist certification
preparation. Passing score: 75% (76 questions correct).
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 1 of {TOTAL}
, SECTION 1 | ECMO Physiology & Fundamentals | Q1-Q21 | ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE
SOLUTIONS!! 2026/2027 2026/2027
Q1 Question 1 of 101
A 58-year-old male with severe acute respiratory distress syndrome is being evaluated for
venovenous ECMO support. The ECMO specialist understands that venovenous ECMO
primarily addresses which physiological deficit?
A. Oxygenation and CO2 removal by bypassing the pulmonary circuit
B. Systemic perfusion by bypassing both the heart and lungs
C. Right ventricular afterload reduction by decompressing the right atrium
D. Left ventricular unloading by redirecting blood from the left atrium
Correct Answer: A
Rationale:
Venovenous ECMO provides gas exchange by oxygenating blood and removing CO2 outside the lungs but
does not provide hemodynamic support. Venoarterial ECMO bypasses both heart and lungs for perfusion,
and ventricular unloading is not the primary mechanism of VV-ECMO.
Q2 Question 2 of 101
A neonate with persistent pulmonary hypertension of the newborn is placed on venoarterial
ECMO via the right internal jugular vein and common carotid artery. The ECMO specialist
explains to the team that VA-ECMO provides which additional benefit compared to
VV-ECMO?
A. Hemodynamic support by directly pumping oxygenated blood into the arterial system
B. Superior oxygenation efficiency because arterial blood has higher oxygen content
C. Reduced risk of hemolysis because the arterial cannula has a larger diameter
D. Elimination of recirculation because venous and arterial cannulas are in separate vessels
Correct Answer: A
Rationale:
VA-ECMO provides hemodynamic support by pumping oxygenated blood directly into the arterial
circulation. VV-ECMO does not provide hemodynamic support. The arterial cannula is typically smaller
than the venous cannula, and recirculation is a VV-ECMO phenomenon, not the key difference between
modes.
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 2 of {TOTAL}
,Q3 Question 3 of 101
A 45-year-old female on VV-ECMO for influenza-related ARDS has a sweep gas flow of 6
L/min and a blood flow of 4 L/min. The blood gas shows a PaCO2 of 58 mmHg. Which
adjustment should the ECMO specialist make first?
A. Increase the sweep gas flow to enhance CO2 clearance across the membrane
oxygenator
B. Increase the blood flow rate to improve oxygen delivery to the patient
C. Decrease the FiO2 on the sweep gas to reduce oxygen toxicity
D. Add a second venous cannula to improve recirculation fraction
Correct Answer: A
Rationale:
Elevated PaCO2 on VV-ECMO is primarily managed by increasing sweep gas flow, which drives CO2
removal across the oxygenator membrane. Blood flow primarily affects oxygenation, FiO2 adjustment does
not address CO2, and adding a second cannula addresses recirculation rather than CO2 clearance.
Q4 Question 4 of 101
A critical care fellow asks the ECMO specialist to explain the concept of recirculation in
VV-ECMO. The specialist describes blood that has just been oxygenated by the circuit
returning directly to the inlet cannula instead of flowing to the patient. Which factor most
increases the recirculation fraction?
A. Close proximity of the drainage and return cannula tips within the same vessel
B. High blood flow rates that exceed the patient's total venous return capacity
C. Low sweep gas flow that reduces the oxygen transfer gradient across the membrane
D. Use of a bicaval dual-lumen cannula positioned in the superior vena cava
Correct Answer: A
Rationale:
Close proximity of drainage and return cannula tips allows oxygenated blood to be drawn back into the
circuit before reaching the patient, increasing recirculation. High blood flow does not inherently cause
recirculation, sweep gas affects gas exchange not recirculation, and properly positioned bicaval dual-lumen
cannulas actually reduce recirculation.
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 3 of {TOTAL}
, Q5 Question 5 of 101
A 62-year-old male on VA-ECMO for cardiogenic shock has a pulse pressure of 10 mmHg
and a mean arterial pressure of 65 mmHg. The ECMO specialist notes diminished pulsatility
on the arterial waveform. Which physiological concept best explains this finding?
A. The continuous flow from the centrifugal pump reduces the natural pulsatile output from
the left ventricle
B. The patient is experiencing tamponade physiology from fluid overload
C. The arterial cannula is obstructed and requires immediate replacement
D. The sweep gas flow is too high and causing excessive CO2 removal
Correct Answer: A
Rationale:
Centrifugal pumps on VA-ECMO produce continuous non-pulsatile flow that diminishes the arterial
pulsatility waveform. While tamponade and cannula obstruction can reduce pulsatility, the most common
explanation is the continuous flow pattern of the circuit. Sweep gas flow affects CO2, not pulsatility.
Q6 Question 6 of 101
A 34-year-old female with fulminant myocarditis is being transitioned from VA-ECMO to
recovery. The team notes improving left ventricular ejection fraction and decreasing lactate
levels. Which physiological finding best indicates adequate native cardiac output recovery?
A. Increasing aortic valve opening and rising pulse pressure with reduced ECMO flow
B. Stable lactate level while maintaining full ECMO support at 4 L/min
C. Decreasing central venous pressure while ECMO flow remains unchanged
D. Rising PaCO2 that requires increased sweep gas flow to normalize
Correct Answer: A
Rationale:
Increasing aortic valve opening and rising pulse pressure indicate the native heart is generating
independent cardiac output as ECMO support is weaned. Stable lactate on full support does not indicate
recovery, unchanged CVP with full support is inconclusive, and rising PaCO2 suggests ventilatory issues
rather than cardiac recovery.
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 4 of {TOTAL}
ECMO CERTIFICATION BOARD
ECMO SPECIALIST EXAM 101 QUESTIONS
WITH COMPLETE SOLUTIONS!! 2026/2027
ECMO SPECIALIST · Official Exam 2026/2027
101 75% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 ECMO Physiology & Fundamentals Q1-Q21
Section 2 ECMO Circuit & Equipment Management Q22-Q42
Section 3 Patient Management on ECMO Q43-Q63
Section 4 ECMO Complications & Emergencies Q64-Q84
Section 5 Quality, Safety & Professional Practice Q85-Q101
Instructions: Select the single best answer for each question. This exam is designed for ECMO Specialist certification
preparation. Passing score: 75% (76 questions correct).
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 1 of {TOTAL}
, SECTION 1 | ECMO Physiology & Fundamentals | Q1-Q21 | ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE
SOLUTIONS!! 2026/2027 2026/2027
Q1 Question 1 of 101
A 58-year-old male with severe acute respiratory distress syndrome is being evaluated for
venovenous ECMO support. The ECMO specialist understands that venovenous ECMO
primarily addresses which physiological deficit?
A. Oxygenation and CO2 removal by bypassing the pulmonary circuit
B. Systemic perfusion by bypassing both the heart and lungs
C. Right ventricular afterload reduction by decompressing the right atrium
D. Left ventricular unloading by redirecting blood from the left atrium
Correct Answer: A
Rationale:
Venovenous ECMO provides gas exchange by oxygenating blood and removing CO2 outside the lungs but
does not provide hemodynamic support. Venoarterial ECMO bypasses both heart and lungs for perfusion,
and ventricular unloading is not the primary mechanism of VV-ECMO.
Q2 Question 2 of 101
A neonate with persistent pulmonary hypertension of the newborn is placed on venoarterial
ECMO via the right internal jugular vein and common carotid artery. The ECMO specialist
explains to the team that VA-ECMO provides which additional benefit compared to
VV-ECMO?
A. Hemodynamic support by directly pumping oxygenated blood into the arterial system
B. Superior oxygenation efficiency because arterial blood has higher oxygen content
C. Reduced risk of hemolysis because the arterial cannula has a larger diameter
D. Elimination of recirculation because venous and arterial cannulas are in separate vessels
Correct Answer: A
Rationale:
VA-ECMO provides hemodynamic support by pumping oxygenated blood directly into the arterial
circulation. VV-ECMO does not provide hemodynamic support. The arterial cannula is typically smaller
than the venous cannula, and recirculation is a VV-ECMO phenomenon, not the key difference between
modes.
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 2 of {TOTAL}
,Q3 Question 3 of 101
A 45-year-old female on VV-ECMO for influenza-related ARDS has a sweep gas flow of 6
L/min and a blood flow of 4 L/min. The blood gas shows a PaCO2 of 58 mmHg. Which
adjustment should the ECMO specialist make first?
A. Increase the sweep gas flow to enhance CO2 clearance across the membrane
oxygenator
B. Increase the blood flow rate to improve oxygen delivery to the patient
C. Decrease the FiO2 on the sweep gas to reduce oxygen toxicity
D. Add a second venous cannula to improve recirculation fraction
Correct Answer: A
Rationale:
Elevated PaCO2 on VV-ECMO is primarily managed by increasing sweep gas flow, which drives CO2
removal across the oxygenator membrane. Blood flow primarily affects oxygenation, FiO2 adjustment does
not address CO2, and adding a second cannula addresses recirculation rather than CO2 clearance.
Q4 Question 4 of 101
A critical care fellow asks the ECMO specialist to explain the concept of recirculation in
VV-ECMO. The specialist describes blood that has just been oxygenated by the circuit
returning directly to the inlet cannula instead of flowing to the patient. Which factor most
increases the recirculation fraction?
A. Close proximity of the drainage and return cannula tips within the same vessel
B. High blood flow rates that exceed the patient's total venous return capacity
C. Low sweep gas flow that reduces the oxygen transfer gradient across the membrane
D. Use of a bicaval dual-lumen cannula positioned in the superior vena cava
Correct Answer: A
Rationale:
Close proximity of drainage and return cannula tips allows oxygenated blood to be drawn back into the
circuit before reaching the patient, increasing recirculation. High blood flow does not inherently cause
recirculation, sweep gas affects gas exchange not recirculation, and properly positioned bicaval dual-lumen
cannulas actually reduce recirculation.
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 3 of {TOTAL}
, Q5 Question 5 of 101
A 62-year-old male on VA-ECMO for cardiogenic shock has a pulse pressure of 10 mmHg
and a mean arterial pressure of 65 mmHg. The ECMO specialist notes diminished pulsatility
on the arterial waveform. Which physiological concept best explains this finding?
A. The continuous flow from the centrifugal pump reduces the natural pulsatile output from
the left ventricle
B. The patient is experiencing tamponade physiology from fluid overload
C. The arterial cannula is obstructed and requires immediate replacement
D. The sweep gas flow is too high and causing excessive CO2 removal
Correct Answer: A
Rationale:
Centrifugal pumps on VA-ECMO produce continuous non-pulsatile flow that diminishes the arterial
pulsatility waveform. While tamponade and cannula obstruction can reduce pulsatility, the most common
explanation is the continuous flow pattern of the circuit. Sweep gas flow affects CO2, not pulsatility.
Q6 Question 6 of 101
A 34-year-old female with fulminant myocarditis is being transitioned from VA-ECMO to
recovery. The team notes improving left ventricular ejection fraction and decreasing lactate
levels. Which physiological finding best indicates adequate native cardiac output recovery?
A. Increasing aortic valve opening and rising pulse pressure with reduced ECMO flow
B. Stable lactate level while maintaining full ECMO support at 4 L/min
C. Decreasing central venous pressure while ECMO flow remains unchanged
D. Rising PaCO2 that requires increased sweep gas flow to normalize
Correct Answer: A
Rationale:
Increasing aortic valve opening and rising pulse pressure indicate the native heart is generating
independent cardiac output as ECMO support is weaned. Stable lactate on full support does not indicate
recovery, unchanged CVP with full support is inconclusive, and rising PaCO2 suggests ventilatory issues
rather than cardiac recovery.
ECMO SPECIALIST EXAM 101 QUESTIONS WITH COMPLETE SOLUTIONS!! 2026/2027 2026/2027 | Passing Score: 75% | Page 4 of {TOTAL}
