Equipment

Question 1

Trace the flow of blood through your circuit from cannula tip to cannula tip.
a. CardioHelp (adult)

Answer 1

1 - Venous Cannula
2 - Pre-pump/Pre-oxygenator/CRRT-Return Pigtail
3 - Venous Sat Probe (Hb, Hct, Venous Temp)
4 - Cardiohelp Centrifugal Pump
5 - Connection for Pressure Monitoring Cable
- Post-pump/Pre-oxygenator/VBG Pigtail
6 - Yellow De-Airing Cap
7 - Oxygenator (7.0)
8 - Post-Pump/Post-Oxygenator/De-airing/CRRT-Pull Pigtail
9 - Post-Pump/Post-Oxygenator/ABG Pigtail
10 - Flow Probe & Bubble Detector
11 - Arterial Cannula

Question 2

CardioHelp (Pediatric)

Answer 2

1 - Venous Cannula
2 - Bridge (Venous Side) & CRRT-Return
3 - Venous Manifold Port
4 - Venous Sat Probe (Hb, Hct, Venous Temp)
5 - Cardiohelp Centrifugal Pump
6 - Connection for Black Pressure Monitoring Cable
- Post-pump/Pre-oxygenator/VBG Pigtail
7 - Yellow De-Airing Cap
8 - Oxygenator (5.0)
8 - Post-Pump/Post-Oxygenator/De-airing Pigtail
9 - Post-Pump/Post-Oxygenator Arterial Manifold Port
10 - Flow Probe & Bubble Detector
11 - Bridge (Arterial Side)
12 - Arterial Cannula

Question 3

Rotaflow Adult Circuit with Spectrum

Answer 3

1 - Venous Cannula
2 - Venous Spectrum Sat Probe (SvO2)
3 - Pre-pump/Pre-oxygenator/CRRT-Return Pigtail
4 - Rotaflow Centrifugal Pump
5 - Post-pump/Pre-oxygenator/VBG Pigtail
6 - Yellow De-Airing Cap
7 - Post-pump/Post-oxygenator/De-airing/CRRT-Pull Pigtail
8 - Post-pump/Post-oxygenator/ABG Pigtail
9 - Spectrum Arterial Sat Probe (Hct, Hb)
10 - Spectrum Flow Probe
11 - Arterial Cannula

Question 4

Neonatal Circuit with Spectrum

Answer 4

1 - Venous Cannula
2 - Venous Spectrum Sat Probe
3 - Venous Manifold Port
4 - Bridge (Venous Side) & CRRT Return
5 - Pre-pump/Pre-oxy Venous Pressure Line (to DLP Red Box)
6 - 2 Pre-pump/Pre-oxygenator Pigtail for Med Infusions
7 - Rotaflow Centrifugal Pump
8 - Pre-Oxygenator Pressure Line (to DLP Red Box)
9 - Oxygenator
10 - Yellow De-Airing Cap
11 - Post-Oxygenator Arterial Pressure Line (to DLP Red Box) &
CRRT-Pull Access
12 - Post-pump/Post-oxygenator Arterial Manifold Port
13 - Spectrum Arterial Sat Probe (Hct, Hb)
14 - Bridge (Arterial Side) & Platelet Infusion Access
15 - Spectrum Flow Probe
16 - Arterial Cannula

Question 5

What is different about the neonatal circuit from the adult Rotaflow and
CardioHelp Circuit

Answer 5

Bridge, more venous pigtails, manifold.

Question 6

What is the function of and location within the circuit of the following:
a. Arterial and venous sat probes

Answer 6

Cardiohelp Venous = Pre-pump on the mounted sensor.
Cardiohelp Arterial = Post-Oxygenator near the pigtail for ABG
Access
Rotaflow Venous (Spectrum Monitor) = External probe near venous
cannula.
Rotaflow Arterial (Spectrum Monitor) = External probe near arterial
cannula.
Neonatal Venous (Spectrum Monitor) = External probe placed
proximal to the patient from the recirculation line from manifold.

Question 7

Pig Tail

Answer 7

Adult Cardiohelp = 4 (venous line, post-pump/pre-oxy, postpump/post-oxy/de-airing, post-pump/post-oxy/ABG).
Pediatric Cardiohelp = 2 (Post-pump/pre-oxy & post-pump/postoxy/de-airing)
Neonatal Circuit = 2 (venous med infusions)

Question 8

Venous Pressure

Answer 8

Adult & Pediatric Cardiohelp = Internal reading pre-pump.
Neonatal Circuit = On a red box connected right after the bridge
(when comparing position to the patient).

Question 9

Pre oxygenator pressure

Answer 9

Adult & Pediatric Cardiohelp = Internal post-pump/pre-oxygenator
Neonatal Circuit = On a red box connected to the post-pump/preoxygenator port (Y’d in with the post-oxygenator pressure).

Question 10

Post oxygenator pressure

Answer 10

Adult & Pediatric Cardiohelp = Internal near the post-pump/postoxygenator/ABG pigtail.
Neonatal Circuit = On a red box connected to the post-pump/postoxygenator port (Y’d in with the pre-oxygenator pressure)

Question 11

Oxygenator

Answer 11

Oxygenates the blood, removes CO2, also acts as the heat
exchanger between the circuit and heater/cooler.
Placed post pump.

Question 12

Rotaflow Centrifugal Pump

Answer 12

Pre-oxygenator, pushed blood into oxygenator.

Question 13

CardioHelp Centrifugal Pump

Answer 13

One unit with the oxygenator (still technically pre-oxygenator within
the circuit).

Question 14

Bridge in neonatal and pediatric CardioHelp Circuit

Answer 14

Neonatal = Venous side is placed between the manifold
recirculation line and the venous pressure line, Arterial side is
Proximal to the Patient.

Question 15

Is there a bubble detector in the neonatal circuit?

Answer 15

No, not in the true sense. Spectrum monitor does have the ability to track
emboli.

Question 16

Where is the blood flow measured in the neonatal circuit?

Answer 16

Spectrum monitor flow probe proximal to the patient on the arterial side

Question 17

Where is blood flow measured in the CardioHelp Circuit?

Answer 17

Flow probe proximal to the patient on the arterial side

Question 18

Where is blood flow measured in the adult Rotaflow circuit?

Answer 18

Spectrum monitor flow probe proximal to the patient on the arterial side.
Needs addition of paste to the pump head directly out of the pump
(not accurate for flows less than 1 Liter), does not account for
flows lost in shunts within the circuit (bridges & manifold).

Question 19

Where is the blood flow measured in the LifeSPARC circuit?

Answer 19

Flow probe proximal to the patient on the arterial side.

Question 20

Where is the blood flow measured in the Centrimag circuit?

Answer 20

Flow probe proximal to the patient on the arterial side.

Question 21

What is the difference between the CardioHelp and Rotaflow centrifugal
pump? How does the Centrimag compare to the other pumps? How does the
LifeSPARC compare to the other pumps?

Answer 21

Cardiohelp is one unit with an oxygenator, has internal measurements,
and uses four channels to disperse the blood throughout the oxygenator. The
rotaflow is a single outlet, resting on a sapphire pin. The centrimag full magnetic
levitation (no bearing). The bearing is a place for clot to form and an area where
temperature can increase, causing hemolysis. The LifeSPARC has a single point
ruby bearing with a 16 mL priming volume and is why it need higher RPMs to reach
the same amounts of flows as the others.

Question 22

Describe oxygenator failure?

Answer 22

Decreased gas exchange. Unable to add oxygen or remove CO2 even with an
increased sweep.

Question 23

What parameters do you evaluate every day to determine how well the
oxygenator is working?

Answer 23

Delta P & Venous Saturation (for VA ECMO).
For VV ECMO you would look at the patient’s saturation.
Recirculation can cause an increased venous saturation

Question 24

What would you see on a patient’s blood gas that might make you think
failure?

Answer 24

PaO2 < 50, Acidosis, PCO2 that is high.

Question 25

What physical things do you check on the circuit to determine the functional status of the oxygenator?

Answer 25

Check for clots, check the gas line

Question 26

What factors might cause an oxygenator to fail?

Answer 26

Clots, Condensation in the Oxygenator, Occluded Gas Exhaust causing increased gas pressures on the membrane. Sighing the membrane is done to expel the condensation from the oxygenator.

Question 27

What might the gas exhaust look like in a failing oxygenator?

Answer 27

If it is pink/red condensation.

Question 28

What might you see in lab values?

Answer 28

High plasma free hemoglobin, poor ABG (pump & patient), decreased patient SpO2.

Question 29

What is the minimum and maximum sweep for a. Neonatal Quadrox

Answer 29

0.1 - 3 L/min

Question 30

What is the minimum and maximum sweep for Pediatric Quadrox

Answer 30

0.1 - 5.6 L/min

Question 31

What is the minimum and maximum sweep for Small Adult Quadrox & 5.0 CardioHelp

Answer 31

0.25 - 10 L/min

Question 32

What is the minimum and maximum sweep for Adult Quadrox & 7.0 CardioHe

Answer 32

0.25 - 14 L/min

Question 33

What is the minimum and maximum sweep for Neonatal Euroset

Answer 33

0.1 - 3 L/min

Question 34

What is the minimum and maximum sweep for Nautilus ECMO Smart Oxygenator

Answer 34

0.25 - 14 L/min (This pump actually has a recommended sweep flow range of 0.25 - 21 L/min, but we will accept the twice the blood flow range for continuity)

Question 35

What is the minimum and maximum blood flow Neonatal Quadrox

Answer 35

0.2 - 1.5 L/min

Question 36

What is the minimum and maximum blood flow Pediatric Quadrox

Answer 36

0.2 - 2.8 L/min

Question 37

What is the minimum and maximum blood flow Small Adult Quadrox & 5.0 CardioHelp

Answer 37

0.5 - 5.0 L/min

Question 38

What is the minimum and maximum blood flow Adult Quadrox & 7.0 CardioHelp

Answer 38

0.5 - 7.0 L/min

Question 39

What is the minimum and maximum blood flow Neonatal Euroset

Answer 39

0.2 - 1.5 L/m

Question 40

What is the minimum and maximum blood flow Nautilus ECMO Smart Oxygenator

Answer 40

0.5 - 7.0 L/min

Question 41

What is an indicator of clot formation within your circuit?

Answer 41

Dark spots in the circuit, increase in delta P, increase in venous pressure and chugging (if clot is in venous cannula), increased arterial pressures if in the arterial cannula, unable to flush/draw from pigtails.

Question 42

What does venous pressure tell you about your patient and the circuit?

Answer 42

An increased venous pressure (chugging) indicates that the patient is hypovolemic. Could also indicate misplacement in the cannula (try decreasing flows some and then flowing back up).

Question 43

Describe the phenomena of recirculation?

Answer 43

When drainage and return cannulas are too close together they will recirculate the blood throughout the circuit and not deliver it to the patient

Question 44

What mode is this most likely to be seen in?

Answer 44

VV ECMO

Question 45

How do you resolve this problem?

Answer 45

Reposition cannulas, decrease flows. Most of the time you will be asked to decrease flows first because the repositioning of cannulas is risky.

Question 46

What are factors affecting recirculation?

Answer 46

Increased blood flow, cannula position.

Question 47

How do you determine if a patient is ready to be weaned from ECMO a. VV ECMO

Answer 47

Improved blood gasses with less support. Underlying issue treated/recovered.

Question 48

Improved blood gasses with less support. Underlying issue treated/recovered.

Answer 48

Improved cardiac function, hemodynamics, EF of 30%, weaning of supporting meds. Underlying issue treated/recovered.

Question 49

How is a patient tested to see if he is ready to be weaned from ECMO?

Answer 49

VA - Peds/Neos are several clamp out trials, Adults will do a low flow trial at 1 Liter or will utilize zero flow mode momentarily (under the direction of a physician) as well as a sweep around 1-2 with 50%ish FIO2. VV - Cap the oxygenators (Peds/Neos - 12 hours, Adults 24 hours). Draw periodic patient ABGs.

Question 50

Describe how the patient is weaned from VV ECMO.

Answer 50

Only wean the sweep. Don’t change the flows. Adults off sweep for 24 hours+, pediatrics is 12 hours+

Question 51

Describe how the patient is weaned in VA ECMO

Answer 51

Will wean the flows as well as the sweep.

Question 52

Why is this procedure different?

Answer 52

VV ECMO supports the pulmonary system. Need to wean based on lung function. VA ECMO supports the cardiac system. Need to wean based on cardiac function.

Question 53

What are potential air traps in the ECMO circuit? a. Oxygenator

Answer 53

Top of the oxygenator, remove air with de-airing membrane and pigtail.

Question 54

What are potential air traps in the ECMO circuit? Cannula

Answer 54

At the connectors, remove air at the nearest pigtail.

Question 55

What are potential air traps in the ECMO circuit? Centrifugal head

Answer 55

With enough air, will stop forward flow. Remove air at the nearest pigtail.

Question 56

When assessing a patient’s oxygenation status on VA ECMO which of the following is the best indicator of adequacy of oxygenation?

Answer 56

Pre-Membrane Saturation``

Question 57

Define hemolysis.

Answer 57

When blood cells rupture

Question 58

What factors in the circuit cause this?

Answer 58

Turbulent flow, increased heat caused by the pump, high pressures due to increased resistance (small cannulas, clot in oxygenator), severe acidosis (making changes to that quickly).`

Question 59

What lab test is drawn to evaluate degree of hemolysis?

Answer 59

Plasma Free Hemoglobin -

Question 60

How do you treat your circuit?

Answer 60

Check for clots, kinks in tubing, pre-membrane pressure <300 mmHg, possibly add albumin to prime, limit negative venous pressure.

Question 61

What is the normal range for this specific test?

Answer 61

< 12 mg/dL (when > 50 mg/dL, discussion to change circuit begins, can cause renal impairment)