ECMO Pre Learning MCQ

Question 1

In the following formula, which aspects are missing that we can manipulate to influence oxygen delivery?

DO2 = ??? X (BO2 x ??? X sO2) + (PaO2 x 0.03)

A - Preload/Afterload/Contractility/Haemoglobin

B - Heart rate/Blood pressure/CO2

C - O2 concentration

D - Respiratory quotient/O2 concentration

Answer 1

A

Question 2

Which of the following is a contraindication for all forms of ECMO?

Select one:
A. Decompensated cardiomyopathy
B. Acute Respiratory Distress Syndrome
C. Severe chronic organ failure
D. Post cardiothoracic surgery

Answer 2

C

Question 3

Which of the following statements regarding VV ECMO is correct?

Select one:
a. Deoxygenated blood is accessed from the superior vena cava and oxygenated blood is returned via the femoral vein
b. A femoro-jugular configuration is never used
c. For femoro-femoral configuration, a multistage access cannula should sit within the superior vena cava and the return should sit within the femoral artery.
d. The access cannula must sit lower than the return cannula

Answer 3

A

Question 4

Which of the following statements regarding VA ECMO are correct? (more than one answer required)

Select one or more:
a. A distal perfusion cannula (“backflow”) is ideal if the return cannula is in the femoral artery
b. Preload is increased in central VA ECMO
c. Differential hypoxia may occur in VA ECMO
d. LV Afterload is reduced using femoral VA ECMO

Answer 4

A and C

Question 5

What is the appropriate term for the cannula pictured?
Select one:
a. Single stage venous access cannula
b. Multi stage venous access cannula
c. Single stage arterial return cannula
d. Multi stage arterial access cannula

Answer 5

C

Question 6

In the event of a life threatening arrhythmia for a patient on VV ECMO which of the following is correct?

Select one:
a. Defibrillation may be performed, do not alter ECMO flow or do CPR
b. CPR and defibrillation may be performed, do not alter the ECMO flow
c. CPR may be performed, do not alter ECMO flow or defibrillate
d. CPR and defibrillation may be performed, the ECMO flow should be increased

Answer 6

B

Question 7

In the event of a life threatening arrhythmia for a patient on VA ECMO which of the following is correct?

Select one:
a. CPR is not required, ECMO flows may be manipulated, defibrillation may be performed
b. CPR is required, ECMO flows must be increased, defibrillation may be performed
c. CPR is not required, ECMO flows may be manipulated, defibrillation must not be performed
d. CPR is required, ECMO flows should be turned down, defibrillation may be performed

Answer 7

A

Question 8

Intervention alarms should be turned ‘off’ in all forms of ECMO?

Select one:
True
False

Answer 8

True

Question 9

In VA ECMO, if both the access and return lumens were dark red, a possible cause could be:

Select one:
a. Recirculation
b. Return lumen migration
c. Oxygen supply failure
d. Access lumen migration

Answer 9

C

Question 10

In VV ECMO, if both the access and return lumens were bright red, a possible cause could be:

Select one:
a. High oxygen delivery
b. Recirculation
c. ECMO working optimally
d. Haemolysis

Answer 10

B

Question 11

Differential hypoxia (more than one answer required):

Select one or more:
a. Is the result of improving native respiratory function and ongoing impairment of cardiac function
b. May be evidenced by poor peripheral SpO2 or PaO2 when measured in the right upper limb
c. Is the result of improving native cardiac function and persistent impairment of respiratory function
d. Can occur in peripheral VA ECMO only

Answer 11

B and D

Question 12

Access insufficiency (more than one answer required)

Select one or more:
a. Is a common occurrence on ECMO and can be treated by decreasing flow
b. Is a common occurrence on ECMO and should be treated by increasing flow
c. Is a common occurrence on ECMO and can be treated with a fluid bolus on each occasion
d.
Is a common occurrence on ECMO and may resolve without intervention

Answer 12

A and D

Question 13

What are the requirements for patient movement / positioning if on peripheral ECMO? (more than one answer required)

Select one or more:
a. Any doctor can be present for repositioning with nursing staff
b. Jordan-Frame for all pressure area care
c. Reposition patient only when an ECMO intensivist is available on the unit
d. Specified individual to anchor & monitor cannula & circuit tubing

Answer 13

C and D

Question 14

nvasive procedures on an ECMO patients should only be performed by the ECMO specialist or under direct supervision?

Select one:
True
False

Answer 14

True

Question 15

What medications / solutions should be used with a high level of caution / avoided in ECMO patients? (more than one answer required)

Select one or more:
a. Chlorhexidine / Alcohol
b. Protamine
c. Heparin
d. Noradrenaline

Answer 15

A and B

Question 16

When connecting continuous renal replacement, which of the following statements are true? (more than one answer required)

Select one or more:
a. Access and return pressures on the CRRT circuit will both be positive
b. The access lumen (CRRT) is connected post-oxygenator and the return lumen (CRRT) is connected pre-oxygenator
c. After a CRRT treatment all blood should be returned as per normal protocol
d. The access lumen (CRRT) is connected pre-oxygenator and the return lumen (CRRT) is connected post-oxygenator

Answer 16

A and B
Carbon dioxide is more soluble in blood than oxygen. This is because the solubility of a gas in a liquid is directly proportional to the partial pressure of the gas above the liquid, and inversely proportional to the temperature of the liquid. In the human body, carbon dioxide is transported in the blood in three forms: dissolved in plasma, bound to hemoglobin, and as bicarbonate ions. Oxygen, on the other hand, is mainly transported in the blood bound to hemoglobin, with a small amount dissolved in plasma. The higher solubility of carbon dioxide in blood allows for more efficient transport of this gas from the tissues to the lungs, where it can be exhaled.

Question 17

Which of the following statements regarding carbon dioxide clearance is correct? (more than one answer required)

Select one or more:
a. Carbon dioxide clearance is affected by manipulating the fresh gas flow
b. We titrate oxygen content of the free gas flow to displace carbon dioxide from blood
c. Lower blood flows can be used via the ECMO circuit if carbon dioxide clearance is the major goal rather than oxygenation
d. Carbon dioxide is more soluble in blood than oxygen

Answer 17

A, B and D
Carbon dioxide is more soluble in blood than oxygen. This is because the solubility of a gas in a liquid is directly proportional to the partial pressure of the gas above the liquid, and inversely proportional to the temperature of the liquid. In the human body, carbon dioxide is transported in the blood in three forms: dissolved in plasma, bound to hemoglobin, and as bicarbonate ions. Oxygen, on the other hand, is mainly transported in the blood bound to hemoglobin, with a small amount dissolved in plasma. The higher solubility of carbon dioxide in blood allows for more efficient transport of this gas from the tissues to the lungs, where it can be exhaled.

Question 18

What is the longest time one could expect a Cardiohelp battery to last?

Select one:
a. 30min
b. 60min
c. 90min
d. 120min

Answer 18

C

Question 19

Whilst transporting a VV ECMO patient the blood in the return and access lines are the same dark colour and the patient has dropped their SpO2, what could the potential cause(s) be? (more than one answer required)

Select one or more:
a. The O2 bottle is empty
b. Differential hypoxia
c. Oxygenator failure
d. Recirculation of blood

Answer 19

A and C

Question 20

VV ECMO is weaned by:

Select one:
a. Reducing ECMO blood flows
b. Reducing oxygenator pressure
c. Reducing fresh gas flow (FGF)
d. Reducing ventilatory support

Answer 20

C

Question 21

VA ECMO is weaned by: (more than one answer required)

Select one or more:
a. Reducing ECMO blood flow
b. Reducing FiO2 via the ECMO circuit
c. Reducing ventilatory support
d. Reducing fresh gas flow

Answer 21

A and D

Question 22

An ECMO circuit is primed using?

Select one:
a. 2 litres of Compound Sodium Lactate with heparin
b. 2 litres of Compound Sodium Lactate without heparin
c. 2 litres of 0.9% sodium chloride with heparin
d. 2 litres of 0.9% sodium chloride without heparin

Answer 22

D

Question 23

Which of the following turns the EMO cardiohelp console on?

Answer 23

A

Question 24

When initiating VA ECMO common settings are (as a ratio):

Select one:
a. Fresh Gas Flow 1 : Blood flow 1
b. Fresh Gas Flow 2 : Blood flow 1
c. Fresh Gas Flow 3 : Blood flow 1
d. Fresh Gas Flow 4 : Blood flow 1

Answer 24

A

Question 25

On initiation of VV ECMO we do not reduce the PaCO2 too quickly, to prevent?

Select one:
a. Shunt and hypoxaemia
b. Haemodynamic instability
c. Myocardial ischaemia
d. Intracerebral haemorrhage

Answer 25

C
On initiation of VV ECMO, we do not reduce the PaCO2 too quickly because of the risk of causing cerebral vasoconstriction and potential cerebral ischemia. The rationale behind this is that a rapid decrease in PaCO2 can lead to a decrease in cerebral blood flow, which may compromise oxygen delivery to the brain. This is particularly important in patients with pre-existing cerebral perfusion issues or those who have undergone a prolonged period of hypoxemia or hypercapnia before ECMO initiation.

Question 26

Sedation requirements in ECMO patients?

Select one:
a. ECMO patients have a much higher sedation requirement than most
b. It is expected that sedation can almost be turned off in the majority of ECMO patients
c. It is expected that ‘normal’ dosages of sedation are sufficient
d. All ECMO patients must be sedated so they can have a neuromuscular blocker infusion as they must not cough or move

Answer 26

A

Question 27

In the event of the LCD screen of the Cardiohelp console being damaged

Select one:
a. Pressing and holding the on/off switch will initiate backup control and allow function to continue
b. No action is needed if the patient is stable
c. Pressing and holding the red covered switch will disable the screen and allow function to continue
d. The circuit must not be clamped and the manual hand crank used immediately

Answer 27

C

Question 28

‘Chatter’ of an ECMO circuit indicates which problem may exist

Select one:
a. Access insufficiency
b. Differential hypoxia
c. Oxygenator thrombosis
d. Loss of pulsatility

Answer 28

A

Question 29

Plasma Free Haemoglobin

Select one:
a. Is an indicator of oxygen delivery
b. Must be sampled every night, at midnight
c. Must be walked to the lab
d. Can be sent in the pathology chute

Answer 29

C

Plasma free hemoglobin (pfHb) is the hemoglobin that is present in the plasma, outside of red blood cells. It is typically measured in milligrams per deciliter (mg/dL) of blood. Hemoglobin is a protein found in red blood cells that carries oxygen from the lungs to the rest of the body and transports carbon dioxide back to the lungs.

In healthy individuals, there is very little free hemoglobin in the plasma, as it is contained within the red blood cells. However, certain conditions or situations can cause red blood cells to break down, releasing hemoglobin into the plasma. These conditions can include hemolytic anemia, blood transfusions, or mechanical damage to red blood cells, such as that which can occur during extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass.

Elevated levels of plasma free hemoglobin can be a sign of hemolysis and may require medical attention. Monitoring plasma free hemoglobin levels is particularly important in patients undergoing ECMO or other treatments that can cause mechanical damage to red blood cells.