VV

Question 1

adult etiologies

Answer 1

respir failure w/ refractory hypoxia
ARDS
alveolar hemorrh
PNA
lung tx

respir failure w/ refractory hypercapnia
copd

Question 2

pediatric specific etiologies

Answer 2

respir failure w/ refractory hypercapnia
asthma

refractory hypoxemia
ards
PNA

mediastinal mass
PE

Question 3

neonate specific etiologies

Answer 3

meconium aspiration
PNA
persistent air leak
severe respir failure (genetic lung dis)
congenital diaphragmatic hernia

Question 4

function of VV

Answer 4

perform ventilation and oxygenation

Question 5

anatomical drain sites

Answer 5

R/L IJ
R/L Femoral Vein

Question 6

anatomical return sites

Answer 6

R/L IJ
R/L Femoral Vein
All locations transport blood to the RA**

Question 7

Does VV impair native cardiac function

Answer 7

Depends..
native blood mixes with ecmo blood in the RA- then Tricuspid, RV, pulmonary valve, pulm arteries, lungs, pulm veins, LA, mitral, LV, aortic valve, aorta

Question 8

Goal pt SVo2/ SCVo2

Answer 8

> 60-85%
trend only- do not use to titrate flow
represents mixing of pt venous blood = recirc pump arterial blood

Question 9

T/F recirculation is always present

Answer 9

T

Question 10

4 main causes recirc

Answer 10

CO
pump flow
RA size
cannula position

Question 11

s/s recirc

Answer 11

pt spo2/sao2 dec
pre oxy ABG SVo2 inc
blood darker

Question 12

Recirc- RA size

Answer 12

smaller RA/ dec preload and intravasc volume = inc r/f recirc
RA needs to be full enough that the ecmo blood can mix well w/ the native

trtmnt
give volume
blood/fluids
stop pulling crrt

Question 13

recirc- pump flow

Answer 13

ECMO blood pressure so high that it shoots past SVC/RA junction and directly down to IVC and drain cannula

fix
turn down flow

Question 14

recirc- CO

Answer 14

poor contractility or arrhythmias can impede foward flow of mixed ecmo blood through pulm circ and to the body

fix
control hr
improve oxygenation
inc BP
echo/XR to eval for tamponade/ inflammation

Question 15

recirc- cannula position

Answer 15

cannula opening twisted towards wall of vena cava
moved up/down and away from tricuspid valve

fix
cxr
echo

Question 16

goal pt spo2

Answer 16

> 85%

Question 17

neonate max flow/ kg

Question 18

main indicator value

Answer 18

pt spo2

Question 19

goal pt Sao2

Answer 19

> 85%
measures percentage of hgb in blood that is fully bound to o2 vs unbound hgb

Question 20

contraindications (adults)

Answer 20

terminal dis
pao2/fio2 <100 for >5 days
significant cns injury
mod- severe chronic lung dis

Question 21

benefits of vv

Answer 21

dec pulm inflamm
reduces ischemic lung injury
no cardiac suppression (doesn’t dec preload, pulm blood flow, LA or LV output)
no LV stun
inc o2 supply to coronary circ

Question 22

parameter used to adjust pt Pao2

Answer 22

FiO2/ flow

Question 23

parameter used to adjust PCo2

Answer 23

sweep

Question 24

reasons for conversion to VA

Answer 24

cardiac arrest
unresponsive pulm failure leading to cardiac compromise
inability to meet pt perfusion needs

Question 25

o2 index

Answer 25

can be used to eval degree of pulm o2 transfer and intensity of vent support needed to maintain oxygenation fio2 x MAP (mean airway P) / pao2 OI 0-25 good outcome > 40 = severe- strongly encourage ecmo

Question 26

goal plateau p

Answer 26

<28 P that lower airways and alveoli experience measured during inspir pause when airflow is 0 indicates-- lung compliance

Question 27

peak p vs plateau p

Answer 27

peak p= total airway resistance amount of P vent has to exert to overcome and deliver breath plateau p= lung compliance- P in lungs during inspiration

Question 28

goal peak p

Answer 28

<25

Question 29

flow is adjusted to maintain what values

Answer 29

sao2 > 85% and trend svo2 >60% (BP supported w/ pressors and volume)

Question 30

common arterial sat sao2/spo2

Answer 30

60-90%

Question 31

goal svo2

Answer 31

>60%

Question 32

purpose of proning

Answer 32

improve intrapulm and postural drainage