Deck 50: Extracorporeal Life Support Ecls

Question 1

What can cause a decrease in pump flow?

A) Both an increase in preload and an increase in afterload
B) Both a decrease in preload and a decrease in afterload
C) An increase in preload or decrease in afterload
D) A decrease in preload or increase in afterload

Answer 1

D
Explanation: A decrease in preload or increase in afterload can cause a decreased pump flow.

Question 2

Your patient is receiving ECMO and requires frequent medications. IV access is limited. The physician asks for your recommendations on ways to improve the ease of medication delivery. What would you suggest?

A) Establish intraosseous (IO) access.
B) Deliver the medications down the endotracheal tube.
C) Utilize the infusion ports along the tubing.
D) Aerosolize the medications.

Answer 2

C
Explanation: Infusion ports can be added along the tubing for infusing medications in patients who have limited IV access. These ports can also be an option for access when Continuous Veno Venous Hemofiltration (CVVH) is required.

Question 3

How is the ECMO system powered?

A) A pump
B) A piston
C) A compressor
D) Gravity

Answer 3

A
Explanation: The ECMO system is powered by the blood pump. The pump function is to draw blood in, either from a venous reservoir (the bladder) or directly from the venous circulation, pump it through the oxygenator and then into the patient.

Question 4

What is thermoelastogram?

A) A specific ECG performed during ECMO
B) The way brain waves are measured during ECMO
C) A method of assessing sedation during ECMO
D) A method of assessing anticoagulation

Question 5

During ECMO what is the primary test for anticoagulation measurement at the bedside?

A) ACT
B) PT
C) PTT
D) INR

Question 6

How is blood flow regulated during ECMO?

A) By dialing in a set RPM
B) By the amount of blood in the ECMO system
C) By administering Levaphed
D) By adjusting the blood temperature in the system

Question 7

Which of the following situations could cause an excessive negative pressure on the right atrium during ECMO?
1) Hypovolemia
2) Insufficient height of the patient
3) A kink in the cannula or circuit tubing
4) Hypervolemia

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 8

Common complications of ECMO include which of the following?
1) Seizures
2) Bleeding
3) Arrhythmias
4) Neurologic complications

A)1 and 3 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 2, 3, and 4

Question 9

Why is anticoagulation required during ECMO?

A) Patients are at risk for DVTs due to immobility.
B) The body tends to activate coagulation when exposed to the nonbiologic surfaces of the cannulas and circuit.
C) Coagulation is suppressed during ECMO.
D) Mechanical ventilation during ECMO causes thrombocytopenia.

Question 10

Place the following statement in the correct order as they happen during normal physiology.
1) O₂ and carbon dioxide are exchanged.
2) Blood is pumped from the right side of the heart to the lungs.
3) The heart pumps oxygenated blood to the major organs and tissues.
4) Blood is returned to the left side of the heart.

A)1, 2, 3, 4
B)2, 1, 4, 3
C)4, 3, 1, 2
D)3, 4, 2, 1

Question 11

ECMO is typically only considered in conditions when conventional support:
1) has not been successful in delivering oxygen (O₂).
2) is unable to effectively remove CO_2.
3) cannot provide adequate cardiac function.
4) has been in use for more than 4 days.

A)1 only
B)1, 2, and 3 only
C)1, 2, and 4 only
D)1, 2, 3, and 4

Question 12

How can the RT monitor for clots in the oxygenator?

A) Draw blood and monitor the PT, PTT, and INR.
B) Monitor pre- and postoxygenator pressures.
C) Observe the tubing for any clots.
D) Use pulse oximetry and capnometry.

Question 13

Which of the following are inclusion criteria for neonatal ECMO?
1) Reversible lung disease
2) Gestational age less than 35 weeks
3) Pulmonary barotrauma
4) Persistent acidosis

A)1 and 3 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 3, and 4 only

Question 14

Which of the following is the typical ratio of sweep flow to pump flow?

A) 1:1
B) 3:1
C) 6:1
D) 9:1

Question 15

During VV ECMO, where are cannulas typically placed?
1) Right internal jugular vein
2) Left femoral vein
3) Right atrium
4) Femoral artery

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 16

Which of the following are considered types of EMCO?
1) VV
2) AV
3) VA

A)1 and 3 only
B)1 and 2 only
C)2 and 3 only
D)1, 2, and 3

Question 17

Guidelines for training an ECMO specialist include which of the following?
1) RT must have a bachelor's degree.
2) ECMO equipment training.
3) Physiology of the diseases supported with ECMO.
4) Physiology of coagulation.

A)1 and 3 only
B)1, 2, 3, and 4
C)3 and 4 only
D)2, 3, and 4 only

Question 18

Which of the following factors affect ACTs level of a patient receiving ECMO?
1) Hypothermia
2) Thrombocytopenia
3) Anemia
4) Hypofibrinogenemia

A)1 and 3 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 2, 3, and 4

Question 19

Which of the following are absolute contraindications for the use of ECMO?
1) Lethal congenital anomalies
2) Grade III or higher intracranial hemorrhage
3) Mechanical ventilation with 100% O₂ for greater than 13 days
4) Gestational age less than 34 weeks

A)1 and 2 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 2, 3, and 4

Question 20

Which of the following are common indications for ECMO?
1) Persistent pulmonary hypertension of the newborn (PPHN)
2) Respiratory distress syndrome (RDS)
3) Meconium aspiration syndrome (MAS)
4) Congenital diaphragmatic hernia (CDH)

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 21

What is a major advantage of ECMO?

A) Mortality rate is much lower than conventional ventilation.
B) The need for hemodynamic monitoring is reduced.
C) It can be used on premature infants less than 28 weeks.
D) The potential of ventilator induced lung injury is reduced.

Question 22

ECMO is not an option as a bridge to transplant.

Question 23

What is the major difference between weaning a patient off of VA ECMO and VV ECMO?

A) The function of the heart must be assessed as increased blood flow is redirected to the native circulation.
B) The pulmonary system of patient's on VA ECMO needs to be weaned using HFOV.
C) VV ECMO weaning does not require the use of a ventilator.
D) VV ECMO patients can be placed on VA ECMO for weaning.

Question 24

During VA ECMO, where is the arterial cannula typically inserted?

A) Aorta
B) Right atrium
C) Pulmonary artery
D) Radial artery

Question 25

Venoarterial is the preferred method for use of ECMO when cardiovascular support is not required.