Question 1

Which of the following patient has the best predicted survival following application of ECMO?

Accepted Answer

A)  5-year-old with liver failure 
B)  6-year-old with pertussis 
C)  1-year-old with respiratory syncytial virus 
D)  10-year-old with sepsis 
A)  5-year-old with liver failure 
B)  6-year-old with pertussis 
C)  1-year-old with respiratory syncytial virus 
D)  10-year-old with sepsis C

Question 2

A neonate on mechanical ventilation with respiratory distress has a PaO2 of 50 mm Hg, a   of 20 cm H2O and FiO2 of 0.8. Why should the therapist suggest therapies other than ECMO?

Accepted Answer

A)  The FiO2 is not 1.0 yet. 
B)  Theis not high enough to justify ECMO. 
C)  The OI does not meet ECMO criteria. 
D)  The PaO2 is within normal limits. 
A)  The FiO2 is not 1.0 yet. 
B)  Theis not high enough to justify ECMO. 
C)  The OI does not meet ECMO criteria. 
D)  The PaO2 is within normal limits. C

Question 3

Which of the following mechanisms affect the output of VV ECMO?
I. Size of the tubing
II. The rotations per minute
III. Tension of the rollers
IV. Patient's blood pressure

Accepted Answer

A)  I, II, and III only 
B)  I and IV only 
C)  II, III, and IV only 
D)  I, II, III, and IV 
A)  I, II, and III only 
B)  I and IV only 
C)  II, III, and IV only 
D)  I, II, III, and IV A

Question 4

Which of the following conditions is considered contraindications for neonatal ECMO?

Accepted Answer

A)  Meconium aspiration 
B)  Less than 2 kg of weight 
C)  Prolonged mechanical ventilation (7-10 days) 
D)  Less than 36 weeks of gestation 
A)  Meconium aspiration 
B)  Less than 2 kg of weight 
C)  Prolonged mechanical ventilation (7-10 days) 
D)  Less than 36 weeks of gestation

Question 5

What is the advantage of having the centrifugal pump automatically respond to resistances against which it is pumping?

Accepted Answer

A)  It avoids placing increased pressures on the heart. 
B)  It eliminates lowering pulmonary vascular pressures. 
C)  It maintains regulated flow through the system. 
D)  It ensures that the blood flows smoothly through the membrane oxygenator. 
A)  It avoids placing increased pressures on the heart. 
B)  It eliminates lowering pulmonary vascular pressures. 
C)  It maintains regulated flow through the system. 
D)  It ensures that the blood flows smoothly through the membrane oxygenator.

Question 6

What is considered the most concerning complication of ECMO in the newborn?

Accepted Answer

A)  Disseminated intravascular coagulopathy 
B)  Pneumonia 
C)  Intracranial hemorrhage 
D)  Hemosiderosis 
A)  Disseminated intravascular coagulopathy 
B)  Pneumonia 
C)  Intracranial hemorrhage 
D)  Hemosiderosis

Question 7

The therapist in charge of a patient on ECMO has noticed an increase in premembrane pressures. What is the most probable explanation?

Accepted Answer

A)  Very high pump flow 
B)  Clotting in the circuit 
C)  Damage of the raceway 
D)  Excessive sweep flow 
A)  Very high pump flow 
B)  Clotting in the circuit 
C)  Damage of the raceway 
D)  Excessive sweep flow

Question 8

Which of the following strategies is greatly responsible for decreasing the need for ECMO in neonates?

Accepted Answer

A)  High-flow oxygen therapy 
B)  Pressure control ventilation 
C)  Heliox 
D)  HFOV 
A)  High-flow oxygen therapy 
B)  Pressure control ventilation 
C)  Heliox 
D)  HFOV

Question 9

Which of the following parameters have been suggested as factors that may help predict outcome for pediatric ECMO?
I. PaO2 2/FiO2 35
IV. Pre-ECMO pH <7.20

Accepted Answer

A)  II, III, and IV only 
B)  I, II, and III only 
C)  I, II, and IV only 
D)  II and IV only 
A)  II, III, and IV only 
B)  I, II, and III only 
C)  I, II, and IV only 
D)  II and IV only

Question 10

During administration of venovenous ECMO, the therapist notices that the SvO2 is greater than SaO2. What is the best explanation to this phenomenon?

Accepted Answer

A)  The blood flow through the pump is too slow. 
B)  Recirculation is excessive. 
C)  Native cardiac output has increased. 
D)  iNO is being administered concomitantly. 
A)  The blood flow through the pump is too slow. 
B)  Recirculation is excessive. 
C)  Native cardiac output has increased. 
D)  iNO is being administered concomitantly.

Question 11

The ECMO specialist has noticed excessive clotting in the circuit despite increase doses of heparin. What is the most feasible explanation for this event?

Accepted Answer

A)  Too many platelet transfusions 
B)  Defective heparin 
C)  Blood flow too slow 
D)  Deficiency of ATIII 
A)  Too many platelet transfusions 
B)  Defective heparin 
C)  Blood flow too slow 
D)  Deficiency of ATIII

Question 12

Which of the following "resting ventilator settings" are typically used in ECMO for respiratory support?
I. PCV-SIMV
II. PIP 20 to 25 cm H2O
III. PEEP 2 to 3 cm H2O
IV. Frequency 12-15

Accepted Answer

A)  I and III only 
B)  II and III only 
C)  I, II, and IV only 
D)  I, II, III, and IV 
A)  I and III only 
B)  II and III only 
C)  I, II, and IV only 
D)  I, II, III, and IV

Question 13

The therapist in charge of a patient on ECMO is monitoring ACT every 30 minutes. The last ACT was 100 seconds. What should the therapist suggest at this time?

Accepted Answer

A)  Decrease the amount of platelets transfused. 
B)  Increase the heparin dose. 
C)  Add plasminogen. 
D)  Increase blood flow to decrease contact time. 
A)  Decrease the amount of platelets transfused. 
B)  Increase the heparin dose. 
C)  Add plasminogen. 
D)  Increase blood flow to decrease contact time.

Question 14

In the gas membrane exchanger, what is one of the limiting factors to the transfer rate of oxygen across the membrane?

Accepted Answer

A)  The flow of blood 
B)  The concentration gradient of the gas across the membrane 
C)  The thickness of the blood film between the membrane layers 
D)  The flow of gas in relationship to the flow of blood 
A)  The flow of blood 
B)  The concentration gradient of the gas across the membrane 
C)  The thickness of the blood film between the membrane layers 
D)  The flow of gas in relationship to the flow of blood

Question 15

Which of the following groups of patients has the highest mortality rate when treated with ECMO?

Accepted Answer

A)  Neonates with respiratory support 
B)  Pediatric patients with cardiac support 
C)  Neonates with cardiac support 
D)  Pediatrics with use as a bridge to heart transplant 
A)  Neonates with respiratory support 
B)  Pediatric patients with cardiac support 
C)  Neonates with cardiac support 
D)  Pediatrics with use as a bridge to heart transplant

Question 16

What are the most common causes of a decrease in venous return in ECMO?
I. Hypervolemic state
II. Malpositioning of the venous cannula
III. Kinking of the cannula
IV. Shifting of the mediastinum

Accepted Answer

A)  I and III only 
B)  II and III only 
C)  I, II, and III only 
D)  II, III, and IV 
A)  I and III only 
B)  II and III only 
C)  I, II, and III only 
D)  II, III, and IV

Question 17

Which of the following are the principle components of the ECMO system?
I. A pump
II. A standardized ECMO circuit
III. A gas exchange device
IV. A ventilator

Accepted Answer

A)  II and III only 
B)  I and IV only 
C)  II, III, and IV only 
D)  I, II, and IV 
A)  II and III only 
B)  I and IV only 
C)  II, III, and IV only 
D)  I, II, and IV

Question 18

Which of the following conditions are cardiac applications of ECMO?
I. High cardiac output syndrome
II. Cardiac arrest
III. Preoperative stabilization
IV. Cardiomyopathy

Accepted Answer

A)  I and II only 
B)  III and IV only 
C)  II, III, and IV only 
D)  I, II, III, and IV 
A)  I and II only 
B)  III and IV only 
C)  II, III, and IV only 
D)  I, II, III, and IV

Question 19

It is not uncommon for patients undergoing ECMO to experience renal failure. What can be done to enhance renal function?

Accepted Answer

A)  Add either colloids or crystalloids to fluid challenge the patient. 
B)  Perform hemofiltration. 
C)  Add either vasodilators or vasoconstrictors. 
D)  Conduct plasmapheresis. 
A)  Add either colloids or crystalloids to fluid challenge the patient. 
B)  Perform hemofiltration. 
C)  Add either vasodilators or vasoconstrictors. 
D)  Conduct plasmapheresis.

Question 20

What is the key reason for making ECMO so successful in newborns?

Accepted Answer

A)  Newborns do not have as a high risk for bleeding as other age groups. 
B)  Newborns require less ECMO flows. 
C)  Newborns have fewer side effects when treated with heparin drips. 
D)  Most clinical conditions treated with ECMO in newborns are reversible. 
A)  Newborns do not have as a high risk for bleeding as other age groups. 
B)  Newborns require less ECMO flows. 
C)  Newborns have fewer side effects when treated with heparin drips. 
D)  Most clinical conditions treated with ECMO in newborns are reversible.

Exam 19: Extracorporeal Membrane Oxygenation

Which of the following patient has the best predicted survival following application of ECMO?

A neonate on mechanical ventilation with respiratory distress has a PaO2 of 50 mm Hg, a of 20 cm H2O and FiO2 of 0.8. Why should the therapist suggest therapies other than ECMO?

Which of the following mechanisms affect the output of VV ECMO? I. Size of the tubing II. The rotations per minute III. Tension of the rollers IV. Patient's blood pressure

Which of the following conditions is considered contraindications for neonatal ECMO?

What is the advantage of having the centrifugal pump automatically respond to resistances against which it is pumping?

What is considered the most concerning complication of ECMO in the newborn?

The therapist in charge of a patient on ECMO has noticed an increase in premembrane pressures. What is the most probable explanation?

Which of the following strategies is greatly responsible for decreasing the need for ECMO in neonates?

Which of the following parameters have been suggested as factors that may help predict outcome for pediatric ECMO? I. PaO2 <50 mm Hg II. PaO2/FiO2 <75 III. OI >35 IV. Pre-ECMO pH <7.20

During administration of venovenous ECMO, the therapist notices that the SvO2 is greater than SaO2. What is the best explanation to this phenomenon?

The ECMO specialist has noticed excessive clotting in the circuit despite increase doses of heparin. What is the most feasible explanation for this event?

Which of the following "resting ventilator settings" are typically used in ECMO for respiratory support? I. PCV-SIMV II. PIP 20 to 25 cm H2O III. PEEP 2 to 3 cm H2O IV. Frequency 12-15

The therapist in charge of a patient on ECMO is monitoring ACT every 30 minutes. The last ACT was 100 seconds. What should the therapist suggest at this time?

In the gas membrane exchanger, what is one of the limiting factors to the transfer rate of oxygen across the membrane?

Which of the following groups of patients has the highest mortality rate when treated with ECMO?

What are the most common causes of a decrease in venous return in ECMO? I. Hypervolemic state II. Malpositioning of the venous cannula III. Kinking of the cannula IV. Shifting of the mediastinum

Which of the following are the principle components of the ECMO system? I. A pump II. A standardized ECMO circuit III. A gas exchange device IV. A ventilator

Which of the following conditions are cardiac applications of ECMO? I. High cardiac output syndrome II. Cardiac arrest III. Preoperative stabilization IV. Cardiomyopathy

It is not uncommon for patients undergoing ECMO to experience renal failure. What can be done to enhance renal function?

What is the key reason for making ECMO so successful in newborns?

Fetal Lung Development

Fetal Gas Exchange and Circulation

Antenatal Assessment and High-Risk Delivery

Examination and Assessment of the Neonatal and Pediatric Patient

Pulmonary Function Testing and Bedside Pulmonary Mechanics

Radiographic Assessment

Pediatric Flexible Bronchoscopy

Invasive Blood Gas Analysis and Cardiovascular Monitoring

Noninvasive Monitoring in Neonatal and Pediatric Care

Oxygen Administration

Aerosols and Administration of Inhaled Medications

Airway Clearance Techniques and Hyperinflation Therapy

Airway Management

Surfactant Replacement Therapy

Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Noninvasive Mechanical Ventilation of the Infant and Child

Invasive Mechanical Ventilation of the Neonate and Pediatric Patient

Administration of Gas Mixtures

Pharmacology

Thoracic Organ Transplantation

Neonatal Pulmonary Disorders

Surgical Disorders in Childhood That Affect Respiratory Care

Congenital Cardiac Defects

Pediatric Sleep-Disordered Breathing

Pediatric Airway Disorders and Parenchymal Lung Diseases

Asthma

Cystic Fibrosis

Acute Respiratory Distress Syndrome

Shock

Pediatric Trauma

Disorders of the Pleura

Neurological and Neuromuscular Disorders

Transport of Infants and Children

Home Care

Quality and Safety

Filters

A neonate on mechanical ventilation with respiratory distress has a PaO₂ of 50 mm Hg, a of 20 cm H₂O and FiO₂ of 0.8. Why should the therapist suggest therapies other than ECMO?

Which of the following parameters have been suggested as factors that may help predict outcome for pediatric ECMO? I. PaO₂ <50 mm Hg II. PaO₂/FiO₂ <75 III. OI >35 IV. Pre-ECMO pH <7.20

During administration of venovenous ECMO, the therapist notices that the SvO₂ is greater than SaO₂. What is the best explanation to this phenomenon?

Which of the following "resting ventilator settings" are typically used in ECMO for respiratory support? I. PCV-SIMV II. PIP 20 to 25 cm H₂O III. PEEP 2 to 3 cm H₂O IV. Frequency 12-15