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CVPR 360 ECMO > ECMO Physiology / Midterm Exam > Flashcards

ECMO Physiology / Midterm Exam Flashcards

1
Q

VA ECMO Cannulation ?

A

– Right Internal Jugular

– Right Common Carotid

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2
Q

Goal or VA ECMO ?

A

80% of the cardiac output (80-100 ml/kg)

– Maintain pulsatile waveform (dampened)

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3
Q

Optimal pulse pressure for VA ECMO ?

A

10 - 15 mmHg

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4
Q

Anything that changes the volume status of the patient will change the ratio of pump to heart flow, such as ?

A

IV,
urine,
edema,
hemoconcentrator

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5
Q

How can we calculate the preload to the pump?

A

CVP = Bladder Pressure

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6
Q

On VA ECMO how can we monitor adequacy of perfusion?

A

SVO2

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7
Q

Adding volume would increase pulse pressure, so therefore what can we expect of the PaO2 ?

A

Drop

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8
Q

Removing volume would decrease our pulse pressure, so therefore what can we expect of the PaO2 ?

A

Increase

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9
Q

Reducing pump flow would increase our pulse pressure, therefore what can we expect of the PaO2 ?

A

decrease

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10
Q

Increasing pump flow would decrease our pulse pressure, therefore what can we expect of the PaO2 ?

A

Increase

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11
Q

VV ECMO Cannulation ?

A

– Withdraw from RA

– Return to RA

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12
Q

Goal of VV ECMO ?

A
  • Increase blood O2 content
    prior to lungs.
  • Dependent on heart for
    patient circulation
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13
Q

What ECMO setup has has no effect on hemodynamics and the patient is dependent on heart for perfusion ?

A

VV ECMO

Wean from inotropes more slowly.

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14
Q

SvO2 monitors recirculation with what ECMO circuit?

A

VV-ECMO

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15
Q

Oxygen CAPACITY definition ?

A

The maximum amount of oxygen the blood is
capable of holding.
(Depends on Hct)
↓ Hct > ↓capacity > ↓ content > ↓ Delivery

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16
Q

Oxygen CONTENT definition ?

A

The amount of oxygen actually in the blood.

CaO2

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17
Q

Oxygen DELIVERY definition ?

A

The amount of oxygen provided to the cells.

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18
Q

Oxygen CONSUMPTION definition ?

A

The amount of oxygen removed from the blood
by the cells.

SvO2

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19
Q

What carries 98% of all

oxygen in the blood?

A

RBC

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20
Q

Hct that would reflect an anemic patient?

A

Plasma 72%

Blood 28%

21
Q

Hct that would reflect an patient with Polycythemia?

A

Plasma 30%

Blood 70%

22
Q

Hct that would reflect a normal patient ?

A

Plasma 55%

Blood 45%

23
Q

Oxygen content CaO2 formula?

A

(Hb x 1.36 x SaO2)+(0.003 x PaO2)

24
Q

[Bound]

1 g Hb (3% Hct) =

A

[Dissolved]

450 mmHg

25
Q

Oxygen delivery DO2 formula =

A

CaO2 x CO

26
Q

C.O. formula =

A

HR X SV

27
Q

S.V. formula =

A

C.O. / HR

28
Q

Oxygen Consumption VO2 formula ?

A

(DaO2 - DvO2) x C.O.

29
Q

Normal newborn Arterial:
SAT 100%
PO2 =
PCO2 =

A 
PO2 = 100
PCO2 = 40
30
Q

Normal newborn Venous:
SAT 75%
PO2 =
PCO2 =

A 
PO2 = 40
PCO2 = 45
31
Q

Mixed Venous Oxygen
Saturation
SVO2 formula =

A

O2 delivered - O2 consumed

32
Q

what does a decrease in SVO2 represent ?

A

indicates that the body
has called upon its last line of defense to
preserve O2 balance and intervention may
be appropriate.

33
Q

What are the 3 different blood samples to evaluate on VA ECMO ?

A

– Venous (pre oxygenator)
– Post Oxygenator
– Patient Arterial (mixed arterial)

34
Q

How would you evaluate Oxygenator function ?

A

Compare pre to post oxygenator blood gas

35
Q

How would you evaluate overall patient support ?

A

Compare patient and

venous blood gases

36
Q

How would you evaluate ECMO vs Patient contribution ?

A

– Compare Post and Patient
blood gases.
– Consider pump flow and
arterial pulsatility

37
Q

Standing orders and parameters to maintain Hct ?

A

Maintain Hct > 40 %

– 10 ml/kg

38
Q

Standing orders and parameters to maintain Platelets ?

A

Maintain Platelets > 100 K
– 1 unit for more than 20K below parameter
– 1/2 unit is less than 20 K below parameter

39
Q

Standing orders and parameters to maintain fibrinogen ?

A

Maintain Fibrinogen >100 K

– 1 unit Cryoprecipitate (about 10 ml)

40
Q

Standing orders and parameters to maintain Flow ?

A

Give 10 ml/kg to maintain flow

– Fluid to be determined

41
Q

Unheparinized pts ACT normal values ?

A

90-120 sec

42
Q

ECMO average ACT range ?

A

160-220 sec

based on patient

43
Q

Uncomplicated TERM patient ECMO ACT range?

A

200-220 sec

44
Q

Uncomplicated PRETERM patient ECMO ACT range?

A

180-200 sec

45
Q

Surgical patient ECMO ACT range?

A

160-180 until hemostasis achieved, then increase parameter.

46
Q

Heparin dose to cannulate ?

Heparin dose to initiate ?

A
  • Bolus 100 u kg

- ACT > 200 sec

47
Q

Heparin management as ACT begins to drop ?

A
  • Start GTT (100u/ml)
  • (monitor frequently)
    50 u/kg/hr to start
  • Titrate GTT up and down to
    maintain ACT
48
Q

I’m having a hard time maintaining my ACT, what is the likely cause and what should I do about it?

A
  • Platelets may decrease ACT, monitor frequently when administering Platelets.
  • Bolus 1/2 previous hours dose
49
Q

Diagnosing low bladder pressure on

(VA and V ECMO)?

A

• CVP

CVPR 360 ECMO (13 decks)

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