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CVPR 360 ECMO > ECMO Circuits / Midterm Exam > Flashcards

ECMO Circuits / Midterm Exam Flashcards

1
Q

What are the two categories why we would ever need to place someone on ECMO?

A
  • Severe Failure to oxygenate

- Cardiac Failure

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2
Q

Name three diffusion problems that would justify us placing a patient on ECMO?

A
  • (HMD) Hyaline Membrane Disease
  • (MAS) Meconium Aspiration Syndrome
  • (ARDS) Acute respiratory distress syndrome
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3
Q

Name two perfusion problems that would justify us placing a patient on ECMO?

A
  • (PPHN) Persistent pulmonary hypertension of the newborn
    AKA (PFC) Persistent fetal circulation
  • CHD
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4
Q

Respiratory distress presents in the first few hours of life in a premature baby. Symptoms include tachypnea, expiratory grunting, nasal flaring. The infant may or may not be cyanosed. Substernal and intercostal retractions may be evident.

Risk factors include maternal diabetes, greater prematurity, prenatal asphyxia and multiple gestation.

Associated abnormalities are those that can occur in prematurity: intracranial haemorrhage, necrotising enterocolitis, patent ductus arteriosus, delayed developmental milestones, hypothermia and hypoglycaemia.

A
  • Hyaline membrane disease(HMD), AKA
  • Neonatal Respiratory Distress Syndrome,
  • Lung Disease of Prematurity, or
  • Surfactant Deficiency,

is a relatively common condition resulting from insufficient production of surfactant.

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5
Q

Pathophysiology of HMD ?

A

Immature type II pneumocytes cannot produce surfactant. The lack of surfactant lowers the surface tension in alveoli causing collapse. Patients have a decreased lecithin:sphingomyelin ratio. Damaged cells, necrotic cells, and mucus line the alveoli.

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6
Q

Subglottic stenosis can result from what ?

A

Long term intubation, this is why we trach our patients after we know that they are going to have to rely on a ventilator.

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7
Q

MAS

A

occurs secondary to intrapartum or intrauterine aspiration of meconium, usually in the setting of fetal distress, and usually in term or post-term infants.

Aspirated meconium can cause small airways obstruction and a chemical pneumonitis.

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8
Q

(PPHN) Persistent pulmonary hypertension of the newborn

AKA (PFC) Persistent fetal circulation

A

is a condition caused by a failure in the systemic circulation and pulmonary circulation to convert from the antenatal circulation pattern to the “normal” pattern.

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9
Q

Name three situations in which we would need to place on ECMO due to cardiac failure?

A
  • Post Bypass
  • BTT
  • Bridge to recovery
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10
Q

Veno - Arterial ECMO cannulation ?

A

RA > Ao

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11
Q

3 Pros for Veno - Arterial ECMO ?

A

– Large body of experience
– Provides cardiac support
– High PaO2

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12
Q

3 CONS for Veno - Arterial ECMO ?

A

– “Cardiac Stun”
– Sacrifice Carotid artery
– Risk of arterial embolus

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13
Q

Veno - Venous ECMO cannulation ?

A

RA > RA via a duel lumen catheter

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14
Q

3 Pros for Veno - Venous ECMO ?

A
  • No arterial embolus
  • Oxygenated blood flow
    into lung beds
  • Preserve carotid artery
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15
Q

3 CONS for Veno - Venous ECMO ?

A
  • Recirculation = low PaO2

- No cardiac support

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16
Q

Cannulation sites for RESPIRATORY Veno - Arterial?

A

Right Internal Jugular => Right Common Carotid

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17
Q

Name the Cannulation sites for Respiratory Veno - Venous ?

A

Right internal Jugular

18
Q

Name the 2 modes of Cannulation for CARDIAC Veno - Arterial?

A

• Trans-thoracic:
RA => Ascending Aorta

• Right IJ => Right Common Carotid

19
Q

Name 5 determinants of venous drainage ?

A
  • Patient volume status (cvp > 5)
  • Cannula size and position
  • Height of bed
  • Patient position
  • Kinks in venous line
20
Q

Name 9 components of the ECMO circuit?

A 
– Venous line
– Bladder
– Roller Pump
– Oxygenator
– Heat exchanger
– Bubble detector
– A-V Bridge
– Sample Ports
– Arterial line
21
Q

Venous line drains blood from the RA, this allow for SVO2 monitoring through an oximetric catheter (SWAN-GANZ), what kind of data can we collect ?

A
  • Adequacy of perfusion
  • Recirculation
  • Flow through cell
22
Q

The BLADDER is a 30 ml silicone collapseable bag that acts as a safety device in 2 ways, what are they?

A
  • Servoregulation of pump

* Bubble collection

23
Q

The BLADDER’s actuation can be ?

A
  • Mechanical or

- Pressure

24
Q

The flow of the roller pump depends on what 3 things ?

A
  • RPMs
  • Tubing Size
  • Proper Occlusion
25
Q

Identify 3 different reason why the roller pump would stop ?

A

Identify 3 different reason why the roller pump would stop ?

26
Q

Top Pump Anatomy ?

A

– Tubing guides, roller, raceway, occlusion

setting, bushings, lid button

27
Q

Front Pump Anatomy ?

A

Speed know, LPM/RMP, cal screw, direction

switch, remote knob, handle

28
Q

Back Pump Anatomy ?

A

Timer, interface recepticles, circuit breaker,

handle,

29
Q

Bottom Pump Anatomy ?

A

Power cord, cooling fan

30
Q

The oxygentator, known as the artificial lung takes over the gas exchange by having a blood phase and a gas phase that is diffusion driven, what is the size of the silicone membrane?

A

0.8 - 4.5 M2

31
Q

QUADROX Technical Data

Blood Flow Rate:
Priming Volume:
Surface Area:
Material of microporous membrane:
Area of heat exchange:
Material of heat exchange capillary:
A

Blood Flow Rate: 0.5 - 7 L/m
Priming Volume: 250 ml
Surface Area: 1.8 m2
Material of microporous membrane: Polypropylene
Area of heat exchange: 0.6 m2
Material of heat exchange capillary: Polyurethane

32
Q

QUADROX D Technical Data

Blood Flow Rate:
Priming Volume:
Surface Area:
Material of microporous membrane:
Area of heat exchange:
Material of heat exchange capillary:
A

Blood Flow Rate: 0.5 - 7 L/m
Priming Volume: 250 ml
Surface Area: 1.8 m2
Material of microporous membrane: Polymethylpentene
Area of heat exchange: 0.6 m2
Material of heat exchange capillary: Polyurethane

33
Q

How would you Diagnose membrane rupture?

A

(blood in the gas phase)

34
Q

How would you Diagnose membrane failure

A

(pre vs post blood gas and

pressures)

35
Q

Where would i draw out a blood sample for ACT on an ECMO circuit ?

A

ACT Port

Pre-Oxygenator

36
Q

Where would you administer platelets, fentanyl, or midazolam on an ECMO circuit?

A

Platelet Port

Post-Oxygenator

37
Q

Where would you administer most fluids and IV boluses on an ECMO circuit ?

A

Push Port Pre-Bladder

38
Q

Bubble detector stats ?

A

8 MHz doppler
1/3 ml bubble detection
last component before the patient

39
Q

When would you utilize the A-V bridge ?

A

– Trial-off

– Crisis management

40
Q

ACT & Labs frequency blood sampling through a pig tail ?

A

ACT : QHR

Labs : PRN

41
Q

Why would we add a hemofilter to our ECMO circuit?

A

Fluid removal

– Edema management

42
Q

ACT for ECMO ?

A

160 - 220

CVPR 360 ECMO (13 decks)

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