Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ECMO > ECMO > Flashcards

ECMO Flashcards

1
Q

Venous blood is drained via a cannula from what location(s) of the patient body?

A

Right Internal Jugular (RIJ)
Superior Vena Cava (SVC)/Right Atrium/Inferior Vena Cava (IVC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Veno-Arterial ECMO oxygenated blood is returned to the patient via a cannula in what location(s) of the body?

A

Aorta (neck/central)
Femoral Artery (peripheral)
Carotid Artery (neonates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Veno-Venous ECMO oxygenated blood is returned via a cannula in what location of the body?

A

RA/Tricuspid Valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

BASIC path of blood flow via ECMO?

A
  1. Patients blood is drained via Venous Drainage Cannula
  2. Venous line to the Pump
  3. Pump to the Oxygenator
  4. Oxygenator to the Return Cannula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The Centrifugal pump is preload … and afterload …

A

dependent
sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the “heart” of the ECMO circuit?

A

the pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the Centrifugal pump pull-in blood?

A

fluid/blood is pulled into the center of the vortex (pump inlet) and pushed toward the outer edge of the path of rotation (pump outlet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patients mush have sufficient … to support desired …

A

preload volume
flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A decrease in volume will decrease

A

flow; “chatter”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anything that increases resistance in the circuit will decrease …

A

flow; including pts SVR on V-A ECMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pump flow is controlled by:

A

RPMs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

To increase flow, what do you increase?

A

RPMs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Are Centrifugal pump flow pulsatile?

A

NO, they are NON-pulsatile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the oxygenator made out of?

A

Polymethylpentene (PMP) - gas permeable fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where does blood flow in the oxygenator?

A

around the outside of the fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In the oxygenator, gas exchange occurs by:

A

true diffusion (surface area, concentration, pressure gradients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What controls ECMO PO2?

A

FiO2 on blender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What controls ECMO PCO2?

A

Sweep Gas (flow meter); can also affect PO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The heater-cooler is incorporated where?

A

the oxygenator; water flows around one side and blood on the other side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardio Quip heater-cooler allows for:

A

temperature management (normo- or hypothermia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the ECMO Circuit made of?

A

PVC tubing and heparin-coated to help prevent thrombosis (bioline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the three locations we can cannulate for ECMO?

A

Central
Neck (neonates/small peds)
Femoral (peds/adults)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Femoral cannulation allows:

A

rapid cannulation in an emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Femoral cannulation may compete with:

A

native cardiac output; retrograde flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Femoral cannulation requires what to be placed?

A

re-perfusion line to prevent lower limb ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Neck cannulation placement for V-A ECMO:

A

RIJ vein and R carotid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Veno-venous ECMO is ONLY for:

A

respiratory support; NO cardiac support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Veno-venous ECMO draws blood from … and returns the blood …: (dual-lumen tube - Avalon)

A

SVC + IVC
directly to the tricuspid valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Veno-venous ECMO, other cannulation site(s):

A
  • femoral vein - femoral vein
    access cannula is low (sub-diaphragmatic)
    return cannula is in the Right Atrium
  • Femoral vein - RIJ
    access cannula is low
    return cannula is in RIJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Indication of ECMO for Adults:

A

ARDS
Pneumonia
Pneumonitis
Status Asthmaticus
Trauma/Pulmonary Contusion
Post-cardiotomy shock
Bridge to/from heart transplant/MCS
hypothermic cardiac arrest
cardiogenic shock
cardiomyopathy
myocarditis
Massive MI
Massive PE
Cardiac Arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Indications for ECMO Pediatric:

A

more often resp. indications; viral PNA, asthma
cardiogenic shock
myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Indications for ECMO Neonates:

A

PPHN
Diaphragmatic Hernia
Meconium Aspiration
Asphyxia
Hypoxic-Ischemic Encephalopathy (HIE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When do we place a patient on ECMO?

A
  • deteriorating cardiopulmonary status despite cardiovascular/respiratory support
    1.) 3+ high dose inotropic and/or vasopressor agents, IABP, Impella
    2.) Hypotension, low CO, worsening acidosis, increasing lactate, decreased U/O
    3.) High Vent Support (PIP, PEEP, Paw, FiO2, HFOV/HFJV, iNO)
    4.) Hypoxemia, hypercarbia, acidosis, worsening CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

VIS - Vasoactive and Inotropes Score for ECMO consideration

A

> 61

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Cardiac Index of pt that requires ECMO

A

<2.0 L/min/m2 ( cardiac output / BSA )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

P/F Ratio potentially requiring ECMO

A

<50 x3 hrs or <80 x6 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Ventilation Index potentially requiring ECMO

A

> 50 x4 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Oxygenation Index potentially requiring ECMO

A

> /= 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Murray Score potentially requiring ECMO
(P/F Ratio, Compliance, PEEP, CXR)

A

> 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When NOT to place pt on ECMO

A
  • Mechanical Ventilation >7 days w/ high settings
  • End-Stage COPD
  • Metastatic CA
  • Multi-System Organ Failure (MSOF)
  • Severe Sepsis
  • CNS Injury ( traumatic, ischemic, embolic, hemorrhagic)
  • Age >70
  • Active Hemorrhage
  • Inability to withstand Anti-coagulation
  • Lack of informed consent/experienced staff/proper equipment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When NOT to place Neonates on ECMO

A

<34 weeks
<2 kgs
Intracranial Hemorrhage
Lethal Chromosomal Anomaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ECMO is NOT a … and only buys …

A

cure
time for healing or medical therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Goal of ECMO is to maintain

A

homeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Veno-arterial ECMO supports CO with

A

pump flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ECMO “full support” in adults: pediatrics:

A

Cardiac Index 2-2.5L/min/m2 (V-A); 3-4 L/min (V-V), 4-5 L/min (V-A)

100-150 ml/kg (V-A); 80 ml/kg (V-V)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

MAP goal on ECMO
CVP goal on ECMO
LAP goal on ECMO

A

35-70 (age dependent)
>10
<10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Venous Gas PO2, PCO2, pH, Sat normal:

A

35-50
40-55
7.30-7.45
65-75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

ECMO Gas PO2, PCO2, pH, Sat normal:

A

200-300
35-45
7.35-7.45
100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Arterial Gas PO2, PCO2, pH, Sat normal:

A

50-150
35-50
7.30-7.45
>90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Typical heparin infusion

A

20-40 units/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Direct Thrombin Inhibitor

A

Bivalirudin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Renal function; normal MAP with pulsatile flow to maintain

A

urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Venous cannula malposition may cause hepatic congestion so watch for climbing

A

CVP with decreasing flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How often should you change cannula site dressing?

A

every 3 days or PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Secure ECMO cannulas to .. and circuit tubing to …:

A

the patient
the bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Cardiohelp has an integrated

A
  • centrifugal pump and oxygenator
  • pressure sensors (pre-pump, post-pump, post-oxygenator)
  • temp. sensor (arterial) and optical measurement via infra-red sensor (venous)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Cardiohelp has 2 different HLS sizes:

A

5.0 (max flow)
7.0 (max flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Venous Cannula/Pre-Pump creates what kind of pressure?

A

NEGATIVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Post-Pump/Arterial Cannula creates what kind of pressure?

A

POSITIVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Delta P on Cardiohelp

A

Pressure difference between Post-Pump/Pre-Oxygenator Internal Pressure and Post-Oxygenator Arterial Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Part on cardiohelp

A

Post-Oxygenator Arterial Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Pint on cardiohelp

A

Post-Pump, Pre-Oxygenator Internal Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Pven on cardiohelp

A

Pre-Pump Venous Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

The Cardiohelp can detect and react to …

A

retrograde flow of blood; back-flow protection - activates zero flow mode automatically to prevent backflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How long does the battery last on Cardiohelp?

A

90 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Cardiohelp screen automatically locks after how long?

A

3 mins of inactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Adult Quadrox-I recommended flow range

A

.5-7 l/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Small Adult Quadrox-I recommended flow range

A

.5-5 L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Pediatric Quadrox-I max flow

A

2.8 L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Neonatal Quadrox-I max flow

A

1.5 L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Nautilus Oxygenators have what type of flow

A

transverse flow path with circular profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Transverse Flow in Nautilus Oxygenators minimize

A

surface contact area while achieviing a low side pressure drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Circular profile in Nautilus Oxygenators eliminates

A

corners where low flow and stasis are known to occur; improvesw long term gas transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Nautilus Oxygenator recommended blood flow rate

A

0.5-7 L/min

75
Q

CentriMag:
Typical RPM?
Typical flow?
Target ACT?
Target PTT?
Max Pump flow?
Max Pressure?

A
  • 3000-4000
  • 4-5 LPM
  • 160-180 ses
  • 50-60 secs
  • 10 LPM
  • 600 mmHg
76
Q

A CentriMag (pump) requires a …

A

motor; each primary console supports 1 CentriMag

77
Q

If CentriMag RPMs are below 1000, what must happen?

A

outflow tubing must be clamped

78
Q

Cardio Quip Normal Mode puts out how much wattage

A

1600w

79
Q

Cardio Quip Low Mode puts out how much wattage

A

800w

80
Q

Cardio Quip:
Water Min … Max …
Max flow rate
Temp. Control

A

1 gal (3.8L) ; 2.5 gal (9.5L)
20 lpm
0-42*

81
Q

Spectrum Monitor; Transit time is the phase delay between

A

the pair of sensors measuring up stream transit time and down stream transit time

82
Q

Spectrum Monitor;
Transit time decreases when
Transit time increases when

A

traveling down stream
traveling up stream

83
Q

Spectrum Monitor; What does it mean if transit times are equal

A

blood flow is static

84
Q

Spectrum Monitor; Emboli is measured by

A

detecting reduction in the ultrasonic signal strength

85
Q

Spectrum Monitor; the level of emboli volume within the flowing blood will be dependent on

A

the level of signal reduction multiplied by the number of signal reduction events

86
Q

Spectrum Monitor;
measures HCT
measures Hgb

A

15-50%
5-17%

87
Q

Veno-Arterial ECMO used in
Veno-Venous ECMO used in
Veno-Arterial/Veno ECMO used in

A

pts with failing hearts
pts with failing lungs
pts with failing heart and lungs; mixing can occur distal to coronaries and lung support is required to perfuse the heart

88
Q

Veno-Arterial ECMO sites:

A

Femoral Vein drainage and Femoral Artery Return
Femoral Vein drainage and Axillary Artery Return
Right Atrium or Femoral Vein drainage and Aorta Return

89
Q

Veno-Arterial/Veno ECMO Site:

A

femoral cannulation with an additional cannula inserted into the Right Atrium and connected to the arterial limb of the circuit

90
Q

Veno-Venous ECMO sites:

A

Internal Jugular w/ Avalon (dual lumen)
Femoral Veins
Internal Jugular and Femoral Vein

91
Q

What do we bolus a patient with before placing ECMO?

A

10,000 units of heparin; 5,000 units of heparin if pt is known to be on heparin

92
Q

ECMO Start:
Initial RPM start
Initial FiO2
Initial Sweep

A

1700 RPMs
80-100%
2-3

93
Q

Indications for ECMO in Neonates

A

Meconium Aspiration
CDH (Congenital Diaphragmatic Hernia)
RDS (Respiratory Distress Syndrom)
Sepsis/PNA
PPHN (Persistant Pulmonary Hypertension)
Air Leak Syndrome
Congenital Airway Abnormalities
Pre-Post Cardiac Surgery

94
Q

Physiologic Criteria for ECMO in Neonates

A
  • Reversible cardiorespiratory failure
  • Oxygenation Index (OI) >40 for >/= 4 hrs
  • OI >20 despite max therapy >/= 24 hrs or decompensation
  • Severe hypoxic respiratory failure w/ acute decompensation (PaO2 <40)
  • Progressive respiratory failure and/or pulmonary hypertension with evidence of right ventricular dysfunction or continued high inotropic requirement
95
Q

Indications for ECMO in Pediatrics

A
  • Post Cardiac Surgery
  • Pulmonary Vasoactive Crisis
  • Cardiomyopathy due to renal failure, myocarditis, burns
  • Acute viral respiratory infections
  • Severe Asthma
  • Bridge to transplant (CF pts)
96
Q

Absolute Contraindications for ECMO in Neonates/Pediatrics

A
  • Catastrophic brain injury without prospect for recovery
  • untreatable metastatic malignancy
  • End-stage organ failure without prospect for recovery or transplant
97
Q

Relative Contraindications for EMCO in Neonates/Pediatrics

A
  • Severe multi-organ failure
  • Severe trauma with coagulopathy and hemorrhage
  • Severe immunocompromised
  • Extremes of age
  • Severe aortic regurgitation
  • Unfavorable vasculature such as aortic dissection
98
Q

Exclusion Criteria for Neonates

A

Gestational Age < 32-34 weeks
Weight < 2 kgs
ICH grade greater than 2
Coagulopathy
Lethal Congenital anomalies
Congenital heart disease rule out
Duration on vent; 10-14 days

99
Q

Exclusion Criteria for Pediatrics

A

Severe CNS injury
Malignancy
Severe immunodeficiency
Advanced liver failure
Pulmonary Fibrosis
Active Hemorrhage
Prolonged Ventilation

100
Q

VV ECMO supplies high oxygenated blood to the:

A

pulmonary circulation and myocardium

101
Q

VV ECMO in neonates spares the

A

carotid artery and may result in shorter cannulation time

102
Q

Neonates: On VV ECMO, the pulmonary bed serves as a

A

filter for any emboli that may occur

103
Q

Neonates: VA ECMO requires

A

ligation of the carotid artery

104
Q

Neonates: VA ECMO provides what kind of blood flow to the body

A

non-pulsatile

105
Q

Neonates: VA ECMO supplies less oxygenated blood to the

A

myocardium

106
Q

Neonates: VA ECMO risks what in the circuit?

A

thrombus that will embolize to the systemic circulation

107
Q

Neonatal: On VA ECMO, they have an increase risk of developing what?

A

neurological complications/developments

108
Q

Technical Complications of ECMO in Neonates

A

bleeding
rupture IVC
vein retraction
rupture atrium
kinking of cannulas
too far in/not in far enough
hepatic perfusion
dislodgement
limb ischemia
“north-south” syndrome

109
Q

Flow (Q)

A

volume - time (ml/min or L/min) movement of a fluid or gas

110
Q

Velocity (V)

A

speed at which fluid moves in a given direction

111
Q

Resistance (R)

A

internal or external forces which oppose flow

112
Q

Pressure (P)

A

force exerted causing fluid movement

113
Q

Pressure Gradient (P1-P2)

A

difference in pressure between two points

114
Q

Viscosity (h)

A

thickness of fluid

115
Q

Fluid flow varies directly with

A

velocity and cross sectional area of its conduit

116
Q

A larger diameter conduit allows

A

the same flow at a reduced velocity

117
Q

A smaller diameter conduit requires

A

an increased fluid velocity to maintain the same flow rate

118
Q

Velocity changes are achieved by

A

changes in pressure

119
Q

To achieve the same flow in a smaller conduit, what must happen

A

velocity must be higher

120
Q

A smaller diameter conduit creates/needs:

A

higher velocity (requires higher pressure)
higher resistance
lower flow
lower volume

121
Q

Fluid ALWAYS moves from:

A

highest to lowest pressure; path of least resistance

122
Q

Flow varies directly with … and varies inversely with …

A

pressure gradient
resistance

123
Q

Two types of flow:

A

laminar flow
turbulent flow

124
Q

Things that cause resistance:

A

conduit length (L)
fluid viscosity (h)
conduit radius

125
Q

Resistance varies directly with … and … and inversely with …

A

conduit length ; fluid viscosity
radius to the 4th power

126
Q

2 ways to Resist

A

Series
Parallel

127
Q

Increase in viscosity:

A
  • lower temperature
  • higher hematocrit
  • higher density (very high platelets, WBC, protein count)
128
Q

Poiseuille Law:
Flow varies directly with … and …
Flow varies inversely with … and …

A

1.) the pressure gradient (P1-P2) and vessel radius to the 4th power (r4)
2.) vessel length (L) and fluid viscosity (h)

129
Q

Poiseuille; to increase flow

A

bigger pressure gradient
bigger diameter conduit (radius)
shorter length conduit
decrease fluid viscosity

130
Q

Poiseuille; things that decrease flow

A

smaller pressure gradient
smaller diameter conduit (radius)
longer length conduit
increased fluid viscosity

131
Q

Centrifugal pumps being afterload sensitive; increased resistance reduces flow with:

A

smaller tubing
smaller cannula
increased SVR
higher hematocrit
circuit geometry (twists, turns, kinks)
clot in oxygenator

132
Q

To maintain flow when resistance increases:

A

increase pressure (increase pump RPMs)

133
Q

A sudden change in flow at the same RPMs indicates:

A

a change in systemic resistance

134
Q

Centrifugal pumps being pre-load dependent; flow will be reduced if:

A
  • venous cannula or venous line has more resistance; cannula too small or cannula mal-positioned (cannula tip pushed against the vessel wall)
  • low CVP (not enough blood volume)
135
Q

Points of high resistance:

A

oxygenator
connectors
small diameter tubing segments
cannulas
kinks
clots
anything w/ a clamp

136
Q

Fluid will always find take the path of least resistance such as:

A

shunts
open bridge
purge lines
leaks

137
Q

Boyles Law

A

gas volume varies inversely with pressure; Increase pressure/Decrease volume - Decrease pressure/Increase Volume

138
Q

Charles Law

A

gas volume varies directly with tempurate; Increase in temperature/Increase volume - Decrease in temperature/Decrease volume

139
Q

Gay-Lussacs Law

A

gas pressure varies directly with temperature;
Increase pressure/Increase Temp - Decrease pressure/Increase Temp

140
Q

Avogadros Law

A

equal volumes of all gases, at the same temperature and pressure, have the same number of molecules

141
Q

Daltons Law

A

the total pressure exerted to equal to the sum of the partial pressure of the individual gases

142
Q

The Ideal Gas Law

A

volume of a gas is directly proportional to the number of moles and temperature of a gas and inversely proportional to the gas pressure

143
Q

Henrys Law of Solubility

A

amount of gas that dissolves in a liquid is directly proportional to the gas solubility coefficient, and the partial pressure of that gas in equilibrium with that liquid

144
Q

Ficks Law of Diffusion

A

the rate of membrane diffusion varies directly with the surface area of the membrane and pressure gradient across the membrane nad varies indirectly with the membrane thickness

145
Q

Oxygen Content (CaO2)

A

(Hgb x 1.34 x SaO2) + (PaO2 x .003)

146
Q

Oxygen Delivery (DO2)

A

CaO2 x CO (or Q=flow rate)

147
Q

Hemoglobin picks up and holds on to oxygen in the lungs and increase HbO2 (Oxy-Hemoglobin) affinity:

A

decrease in hydrogen (acid)
decrease in PCO2
decrease temperature

148
Q

Hemoglobin unloads oxygen at the tissues and has a decreased in HbO2 affinity:

A

increase in hydrogen (acid)
increase PCO2
increase Temperature

149
Q

Oxygen Consumption (VO2)

A

CO L/min x (CaO2 - CvO2)ml/L

150
Q

O2 Extraction Ratio (O2ER)
O2ER normal or DO2:VO2 ratio

A

VO2/DO2 x 100
20-25% or 4-5:1

151
Q

CO2 is transported as:

A

Dissolved CO2 in plasma - 5%
Bound to plasma proteins - 5%
Bound to Hemoglobin in RBC - 20%
Bicarbonate in Plasma - 70%

152
Q

CO=

A

HR x Stroke Volume (mL/beat)

153
Q

Stroke Volume depends on:

A

preload
contractility
afterload

154
Q

Normal CO:
Adults
Neonates

A

60-70 mL/kg/min or 2.6-3.2 L/min/m2
150-200 mL/kg/min

155
Q

Preload - how full is the heart/circulatory system?

A

CVP (central venous or right atrial pressure)
LAP (Left Atrial Presure) - PCWP (pulmonary capillary wedge pressure) or PAD (pulmonary artery diastolic pressure)

156
Q

Afterload - how much resistance does the heart push againts?

A

SVR - systemic vascular resistance (LV)
PVR - pulmonary vascular resistance (RV)

157
Q

Stroke Volume + afterload =

A

blood pressure (Arterial BP or PAP)

158
Q
  1. Normal PAP Systolic/Diastolic
  2. Normal Right Atrium
  3. Normal Right Ventricle
  4. Normal Aorta Systolic/Diastolic
  5. Normal Left Atrium
  6. Normal Left Ventricle
  7. Normal Pulmonary Artery Wedge Pressure
A
  1. S: 15-25 mmHg, D: 8-15 mmHg
  2. 0-8 mmHg
  3. S: 15-25 mmHg, D: 0-8 mmHg
  4. S: 110-130 mmHg, D: 70-80 mmHg
  5. 4-12 mmHg
  6. S: 110-130 mmHg, D: 4-12 mmHg
  7. 8-12 mmHg
159
Q

Frank Starling Law of the Heart

A

increased filling pressure stretches the heart and increases its force of contraction

160
Q

Increasing the force of contraction expels more blood from the left ventricle so that …

A

cardiac output increases when the preload increase

161
Q

ECMO can augment, support, or replace all of the patients requirements for:

A
  • Oxygenation in respiratory failure (O2 content)
  • CO2 clearance in ventilatory/resp. failure (CO2 transport)
  • Circulatory support in the acute heart failure or circulatory collapse (Cardiac Output and O2 Delivery)
162
Q

Clotting Cascade:
Contact Activation/Intrinsic Pathway

A
  • XII -> XIIa -> XI -> XIa -> IX -> IXa -> X -> Xa
  • twelvE -> EleveN -> NinE -> eight -> Ten
163
Q

Clotting Cascade:
Tissue Factor - Extrinsic Pathway

A

VII -> VIIa -> Xa

164
Q

Clotting Cascade:
Common Pathway

A

X -> Xa -> Prothrombin (II) -> Thrombin (IIa) -> Fibrinogen (I) -> Fibrin (Ia)(binds platelets)

165
Q

Clotting Cascade:
Clot formation

A

ADP/Thromboxane/Thrombin
Platelet ——–^——>
Platelet Activation –(GP IIb/IIIa)–> Platelet Aggregation (platelet activation + fibrin (Ia)

166
Q

Platelet activation occurs due to

A

thrombin generation

167
Q

Thrombocytopenia occurs due to

A

increased platelet activation and aggregation

168
Q

Factor XIIa reaches max concentration within … of ECMO initiation

A

10 mins

169
Q

Activation of the intrinsic and extrinsic pathways lead to activation of

A

Factor X

170
Q

Thrombin:

A

increases expression of pro-inflammatory mediators causing neutrophil activation
induces endothelial cell production of platelet activating factor

171
Q

Fibrin:

A

clot formation

172
Q

Complement Activation elevate levels within … of ECMO initiation

A

2 hours

173
Q

Increase complement products contribute to

A

platelet activation and aggregation

174
Q

Thrombin stimulates the release of

A

tissue plasminogen activator (t-PA)

175
Q

t-PA converts plasminogen to

A

plasmin

176
Q

Plasmin breaks down

A

fibrin (and fibrinogen) into fibrin degradation products; fibrinolysis

177
Q

Unfractionated Heparin binds to:

A

anti-thrombin III (AT) and inactivates thrombin (factor IIa) and factor Xa; prevents conversion of fibrinogen to fibrin

178
Q

Initiation of Heparin prior to cannulation:
Check aPTT every … from bolus until aPTT …

A

10,000 units
1 hr from 10,000 heparin bolus ; <80

179
Q

Target aPTT on Bivalirudin

A

60-80 seconds

180
Q

ACT goal

A

180-220 seconds

181
Q

anti-Xa assay goal

A

0.3-.7 IU/ml

182
Q

aPTT assay goal with Heparin

A

70-110 seconds correlates with anti-Xa 0.3-.7 IU/ml
MAX aPTT 150 seconds

183
Q
A

ECMO (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions