ECMO Specialist Knowledge Assessment

This personal ECMO Specialist knowledge assessment is a tool that you can use to evaluate your knowledge and understanding of ECLS, the associated devices, basic anatomy, and other content helpful within the profession. Test your knowledge by answering the questions below while you are able to visually identify components of the ECLS circuit.

1.     Identify the pump head and describe the purpose

2.     Identify the oxygenator and discuss its purpose

3.     Identify the blender and discuss its purpose

4.     Identify the gas lines and discuss their purpose

5.     Write out the blood flow through the heart including naming the valves - starting from the SVC/IVC

6.     What is the significance in placing an arterial line in the right upper extremity in a patient being managed on VA ECLS?

7.     What are your safety checks to be performed at the beginning of each shift?

8.     What safety equipment is needed while managing a patient with ECLS therapy?

9.     Why should a patient on ECLS therapy be adequately anticoagulated?

10.  Is there significance related to anticoagulation if the patient is on VV or VA ECLS? If so what is the significance.

11.  What lab values are used to check for hemolysis? What is the normal value?

12.  How would you be able to identify if the VV dual lumen ECLS cannula is in the wrong position? 

13.  Describe the actions you would take once you identify malposition of the VV dual lumen cannula.

14.  Discuss interventions you would take if the arterial (return) cannula on VA ECLS ruptures at joint.

15.  Discuss interventions you would take if the venous (inflow) cannula on VA ECLS ruptures at a joint.

16.  Your patient is centrally cannulated on VA ECLS. You notice that your patient’s blood pressure reads 50/40. The rhythm is VT. What should you do?

17.  Your patient is on VA ECLS. One hour ago your patient’s blood pressure was 80/50 with a MAP of 60. Now, your arterial waveform is flat with a MAP of 60. What does this mean, what infusion would you potentially expect to start, how would you intervene?

18.  The patient has a right IJ cannula on VV ECLS. During ambulation they faint with SVO2 reading 30% and spO2 that reads 50%. What is the problem and what should you do?

19.  The patient’s rhythm is ventricular fibrillation. They are cannulated for VV ECLS. What should you do?

20.  How can you identify that a patient is hypovolemic on VV and VA ECLS?

21.  What pump pressure reading changes will you notice when a patient is extremely hypovolemic and hypotensive?

22.  A post-op CABG day 0 code is in progress. The cardio-thoracic surgeon is at bedside and wants to cannulate. What do you need and how do you respond?

23.  What type of cannulation and ECLS therapy would you expect for the patient in the question above?

24.  A large air bubble is trapped in the venous (pre oxygenator) cannula. How should you respond?

25.  The adult patient is on VV ECLS and has a right IJ dual lumen catheter. You are using the cardiohelp circuit. You note within a minute that the flow is fluctuating between 2.5 and 3.5. The pVen fluctuates between -80 and -150. The Hgb reads 6.2 and SVO2 reads 52. Is this normal? If not, what is happening and how would you respond?

26.  Discuss the steps of drawing a pre and post oxygenator gas.

27.  What is the purpose of drawing a pre and post gas, what are the normal expected values of the pO2 on the post oxygenator gas?

28.  The adult patient is on VA ECLS with fem-fem cannulation. Why is it important to ensure adequate perfusion to the lower extremities? What additional interventions to cannula blood flow would you expect to see in order to maintain this?

29.  The pump has completely shut down 30 seconds ago and no one knows why. What should you do?

30.  What are the steps and process of weaning VA ECLS?

31.  How would you know your patient is not tolerating the VA wean?

32.  What can be done to help improve a VA wean (pharmacologically)?

33.  What are the steps and process of weaning VV ECLS?

34.  How would you know your patient is not tolerating the VV wean?

35.  The adult patient is intubated on a weaning trial after 14 days of VV ECLS. The flow is 3, sweep is .5, FiO2 100. There have been an increasing amount of clots and fibrin in the oxygenator over the last 24 hours. You draw an ABG and that pO2 is 150. Within a period of one hour, the deltaP changes from 25 to 50. What is happening and what should you do?

36.  What does the sweep gas flow do?

37.  What are the indications to adjusting the sweep?

38.  The patient is on VV ECLS with groin/IJ cannulation. While performing your safety checks, you notice that both cannulas are bright red in color. You draw a gas and the patient’s pO2 is 50 on 75% FiO2 from the ventilator. What is happening and how should you respond?

39.  The ACT result is 205 after day 2 of VA ECLS. There is a small amount of oozing from the cannula sites. Is this normal? What should you do?

40. What is one scenario that you have encountered while managing a patient on ECMO where you had to intervene quickly and think critically? Did you respond appropriately? What would