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ECMO Study Guide > General Questions > Flashcards

General Questions Flashcards

1
Q

The ultimate goal of ECLS

A

Buy time for treatment modalities to work

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2
Q

The most common bacterial pneumonia is caused by

A

Streptococcus (most common community acquired pneumonia).

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3
Q

You are told they are transferring a 1.5 kg child for ECMO (Patient should be
2 kg or more).
a. What should you do to be prepared for infant?

A

Nothing

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4
Q

What is the minimum weight for ECMO? (Why)

A

2 kg - cannula size

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5
Q

What is the maximum weight for ECMO? (Why)

A

50 BMI for VV with lots of support/push, 40 BMI otherwise.

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6
Q

What is minimum gestational age? (Explain)

A

34 weeks

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7
Q

Cardiac output

A

Amount of blood pumped by the heart in L/min

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8
Q

Cardiac index

A

CO/BSA = CI

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9
Q

BSA

A

Body Surface Area

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10
Q

CO= HR X SV

A

For Native Cardiac Function

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11
Q

CO = CI X BSA

A

Used to assess our ECMo Flowh

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12
Q

Define viscosity

A

How thick the blood is.

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13
Q

How does viscosity affect ECMO flow?

A

If the blood is thicker, it can decrease flows.

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14
Q

Define afterload

A

The amount of resistance that the heart has to overcome to open the aortic valve.
On ECMO, afterload is the patient’s blood pressure or cannula size resistance

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15
Q

Define preload

A

Volume of blood in the ventricle & your end diastolic pressure.

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16
Q

Explain what increased preload does to the ECMO flow.

A

It allows you to be able to flow more (negative pressure would become less negative).
Would not limit your ability to flow

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17
Q

Explain what decreased preload does to the ECMO flow.

A

On ECMO, preload is determined by the amount of volume in the patient and can
decrease flows if preload is decreased.

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18
Q

Explain how increased afterload affects ECMO. Describe what you would see on the pressure monitor for the patient and what the CardioHelp would read.

A

It would decrease your flows. The arterial pressure would increase.

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19
Q

Explain how decreased afterload affects ECMO.

A

It would increase your flows.

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20
Q

What is the initial bolus of heparin for a 3.5 kg infant?

A

350 IU

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21
Q

What is the bolus dose of heparin for a 100 KG adult? 75 KG adult?

A

10,000 IU

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22
Q

What is the priming volume for the Rotaflow pump?

A

32 mL

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23
Q

What is the priming volume for the CentriMag pump?

A

31 mL

24
Q

Oxygen content = (________ x 1.34 x________) + (________x 0.0031)
What are two important variables in this equation?

A

Oxygen Content = (Hb x 1.34 x SaO2) + (PaO2 x 0.0031)
Two most important variable are Hb & SaO2

25
Q

For each variable list one action you could take that would improve the O2
content and therefore improve O2 delivery.

A

Increase flows, increase FiO2, increase Hb.

26
Q

Oxygen delivery = _________ X _________

A

Oxygen Delivery = CaO2 x CO

27
Q

What is the best indicator of oxygen delivery on VA ECMO?

A

ECMO SvO2

28
Q

What is the best indicator of oxygen delivery on VV ECMO?

A

Patient SpO2, patient gasses.

29
Q

What influences oxygen delivery on VV ECMO?

A

Patient’s lungs, recirculation, Hb, Cardiac Output, FiO2

30
Q

What influences oxygen delivery on VA ECMO?

A

Hb, CO, FiO2

31
Q

What pressures are monitored in a neonatal/pediatric circuit? What is the significance of each pressure?

A

Venous pressure, Pre-membrane pressure, Post-membrane pressure.
Venous - monitors patient volume statues
Pre-membrane - monitors the oxygenator for clots
Post-membrane - monitors afterload

32
Q

What pressures are monitored in the CardioHelp circuit? What is the significance of
each pressure?

A

Venous pressure, Pre-membrane pressure, Post-membrane pressure.
Venous - monitors patient volume statues
Pre-membrane - monitors the oxygenator for clots
Post-membrane - monitors afterload

33
Q

What pressures are monitored in the adult Rotaflow circuit? What is the significance of
each pressure?

A

With Quadrox - no pressure monitoring.
With Nautilus - Pre-membrane and Post-membrane.
Pre-membrane - monitors the oxygenator for clots
Post-membrane - monitors afterload

34
Q

What parameters are monitored by the venous probe on the CardioHelp?

A

Hb, Hct, SvO2 & Venous Temp

35
Q

What parameters are monitored by the Spectrum? Is this an on line or in line device?

A

Venous Probe (SvO2).
Arterial Probe (Hb, Hct, SaO2)
Flow Probe (Blood flows, bubbles)

36
Q

Describe Zero flow mode on the CardioHelp circuit. When would this be used?

A

A mode that can be manually set to periodically allow for the pump RPMs to be on to
adjust for just enough flow to prevent backflow but not have any forward flow. Used to
assess a patient’s native CO during weaning without having to place clamps on the lin e.

37
Q

What is the most common complication in ECLS? Why?

A

Bleeding, anticoagulation.

38
Q

List 4 reasons you might emergently remove a patient from ECMO.

A
  1. Excessive Bleeding
  2. ICH
  3. Air Embolism/Clots
  4. Accidental Decannulation
39
Q

List 5 causes of circuit air entrainment.

A
  1. Venous pigtail open on the negative pressure side.
  2. Air from central lines (albumin on a pressure bag).
  3. High negative pressures causing cavitation.
  4. Cracked hard plastics within the venous side of circuit.
  5. From the oxygenator - blocked gas exhaust causes increased gas membrane
    pressures that can rupture the membrane and allow gas to bubble straight into
    the blood side.
40
Q

Define recirculation? List 4 factors that affect recirculation.

A

When the blood from the return cannula is pulled directly into the pull cannula without
being directed to the patient.
1. Cannula position and design.
2. Pump flow.
3. Cardiac Output
4. Intravascular Volume

41
Q

What is the major limiting factor for ECLS blood flow?

A

Decreased Preload

42
Q

If your pCO2is high what do you do to the sweep gas flow rate? At what increments is
the sweep gas flow rate changed? How is the change assessed?

A

Increase.
Adults 0.5-1 L/min, for Neonates 0.1, for Peds 0.2-0.5
Redraw an ABG

43
Q

What is measured by the Hemochron Signature Elite?

A

Blood coagulation on fresh whole blood. ACT - activated clotting time.

44
Q

How is a parameter “armed” for the CardioHelp?

A

In the Chain-Link page. You have to go into each parameter and arm manually (or
disarm manually!)

45
Q

Can you describe the steps for getting the CardioHelp circuit ready to hand up to the
surgeon?

A
  1. Clamp the venous and arterial lines near the oxygenator with tubing clamps.
  2. Clamp all 4 big white robertson clamps.
  3. Break it apart using the quick disconnects and connect them forming a loop.
  4. Open the circuit to be handed up to the surgeon sterile.
  5. Instruct to clamp and cut the circuit. (Clamp at the stickers indicated, cut between
    the clamps and quick connect.
46
Q

What is the difference between the CardioHelp and the Rotaflow pump head?

A

Cardiohelp is built into the oxygenator, and it has 4 outflow channels to distribute flow more uniformly throughout the oxygenator.
Rotaflow is a single outlet pump that uses a sapphire bearing.

47
Q

What are signs of cardiac tamponade on VA ECMO?

A

Decrease flows, venous line chugging & more negative venous line pressure due to
decreased venous return to the heart causing decreased preload. Pulsatility would
decrease, or go away completely.

48
Q

What are signs of tension pneumothorax on VV ECMO?

A

Decreased lung compliance, decreased SpO2, decreased flows due to decreased
venous return to the heart causing a decreased preload.

49
Q

What parameters do you inspect when doing your circuit checks? How often are they
done? How often are they charted?

A

All of your parameters! Pressures, flows, sweep, FiO2, temperatures, saturations, circuit
is clear of clots/air, gas exhaust is free from obstruction.
Every hour - charting (+ more often for significant events) & reperfusion cannula checks.
Every two hours - sigh the membrane.
Every 4 hours - flush pigtails (plus more often as clot formations form).

50
Q

Which screen on the CardioHelp allows you to store your lab values?

A

Press the little folder button within either the SvO2, Hct or Hb.

51
Q

What device is used for CRRT?

A

NxSTAGE

52
Q

What line is clamped on CentriMag when changing pump to another external drive?

A

Both venous and arterial lines closest to the patient.
(Company will teach you to clamp only near the outflow of the pump.)

53
Q

What is the minimum RPM’s to be sure of forward flow in Centrimag, CardioHelp and
Rotaflow pumps? Why is this important?

A

1700 RPMs - backflow is bad

54
Q

Where are primed ECMO circuits stored in this hospital?

A

OR - outside of room 21
NeoMart
ECMO room - PICU
CSICU - outside of room 134

55
Q

List 4 blood products that your patient may receive. How is each product given for
neonates? Does it make a difference if your patient is a neonate or an adult?

A

pRBCs - venous side, infusion port, with a syringe pump
FFP - venous side, infusion port, with a syringe pump
Platelets - arterial side of the bridge, manually pushed 5cc every 5 minutes, flush after
giving the entire dose.
Cryo - arterial side of the bridge, manually pushed 5cc every 5 minutes, flush after
giving the entire dose.
All products are given peripherally for adults.
For pediatrics, still give pRBCs and Albumin in the venous side. Prefer to give platelets
peripherally but will give on the arterial side of the bridge if access is limited.

56
Q

Describe when crystalloid, albumin (5% and 25%) and blood products are transfused.

A

Hypovolemia causes a decreased preload that causes decreased flow. Nothing placed
on a pressure bag for ECMO patients in the CSICU.
Crystalloid used with Hct is high and volume is needed.
Albumin used to pull in any volume that is 3rd spacing in the extravascular space.
Blood products are used to treat specifics.

ECMO Study Guide (5 decks)

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