ECMO

Question 1

Sweep definition

Answer 1

rate of oxygen pumped through the membrane oxygenator

Question 2

Flow

Answer 2

Amount of blood pumped by machine. Similar to cardiac output in VA ecmo

Question 3

Score for mortality on VA ecmo

Answer 3

SAVE score

Question 4

Score for mortality in VV ecmo

Answer 4

RESP score

Question 5

Mortality risk to consider ECMO vs start it

Answer 5

Consider when mortality 50% or greater

Start when 80% or greater

Question 6

Mortality with a PaO2/FIO2 ratio < 150 on > 90% FIO2 or a Murray Score of 2-3

Answer 6

50%

Question 7

Mortality with a PaO2/FIO2 ratio < 100 on > 90% FIO2 or Murray score of 3-4

Answer 7

80%

Question 8

Peep and pressure goals on the ventilator while on ecmo

Answer 8

High peep (10-15) and low pressure (peak < 25)

Question 9

FIO2 on the ventilator on patients with ecmo

Answer 9

< 60%

Question 10

3 components of ecmo

Answer 10

Pump, membrane oxygenator, and cannulas

Question 11

Increasing sweep gas flow changes what parameter?

Answer 11

Amount of CO2 removed

Question 12

2 criteria to benefit from ecmo if the patient has undergone optimization for ARDS first.

Answer 12

PaO2/FIO2 ratio < 50-80 for several hours

or

pH < 7.25 with PaCO2 > 60

Question 13

3 components of “lung rest” when placed on VV ecmo

Answer 13

Ultraprotective lung ventilation (< 4 ml/kg)

Pressure limited vent mode (PC)

RR 8-10/min with peep 10

Question 14

Complication on ecmo where the wall of the vessel is sucked up against the cannula and the RPM’s will vary and the tubing will shake back and forth

Answer 14

Chattering

Question 15

Cause of chattering on ecmo

Answer 15

low blood volume so pump is preload dependent

Question 16

Treatment for chattering on ecmo

Answer 16

Increase blood volume and decrease RPMs

Question 17

Normal oxygen sat on ecmo

Answer 17

70-80%

Question 18

Amount of patient’s total cardiac output that should be from the VV ecmo

Answer 18

60-70%

Question 19

Causes of hypoxemia while on VV ecmo

Answer 19

Increase in patient’s intrinsic cardiac output

Membrane failure

Recirculation

Question 20

Combined VV and VA ecmo name

Answer 20

V-AV ecmo

Question 21

Condition where lungs are injured and not oxygenating but heart is also bad and recovering so they are on VA ecmo but the upper extremities are cyanotic but the lower extremities are normal

Answer 21

Differential hypoxemia

Question 22

Treatment for differential hypoxemia on ecmo

Answer 22

V-AV ecmo

Question 23

4 goals for VA ecmo

Answer 23

1. Pulse pressure > 15 (try to keep the native heart beating and not overwhelmed by ecmo pressure)
2. Normal lactate
3. Urine output > 0.5 ml/kg/hr
4. MAP 65-80 mmHg

Question 24

2 complications from VA ecmo when cannula/aortic pressure is greater than the intrinsic heart pressure

Answer 24

Dilated left ventricle

LV thrombus

Question 25

Criteria to stop VV ecmo

Answer 25

ability to have sweep gas completely off

Question 26

Criteria to stop VA ecmo

Answer 26

Normal echo with ecmo circuit turned down

Question 27

Version of ecmo that has to be decannulated in the operating room

Answer 27

VA ecmo