Post-Cardiac Arrest AKI on VA-ECMO: When the Heart Restarts but the Kidneys Struggle – Questions

💔 Post-Cardiac Arrest AKI on VA-ECMO: When the Heart Restarts but the Kidneys Struggle 💧

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1. In patients supported on VA ECMO, the higher incidence of acute kidney injury (AKI) is primarily attributed to:

A. Hypoperfusion secondary to high ECMO flow rates

B. Loss of pulsatile renal blood flow and hemolysis-related injury

C. Use of nephrotoxic antibiotics during ECMO

D. Low circuit pressures from the ECMO pump

2. Regarding CRRT integration into an ECMO circuit, which of the following configurations carries the lowest risk of circuit air entrainment?

A. Both limbs pre-pump (drainage side)

B. Both limbs post-pump (return side)

C. Arterial limb pre-pump, venous limb post-pump

D. Venous limb pre-pump, arterial limb post-pump

3. In ECMO-CRRT combination therapy, regional citrate anticoagulation (RCA) is:

A. Proven superior to systemic heparin in prolonging filter life

B. Contraindicated due to citrate accumulation in ECMO patients

C. Considered a viable but not definitively superior strategy due to limited evidence

D. Routinely recommended by current international ECMO guidelines

4. The main mechanism contributing to AKI after cardiac arrest in patients supported with ECMO is:

A. Catecholamine-induced renal vasoconstriction alone

B. Hemolysis and loss of pulsatile perfusion from mechanical support

C. Hyperosmolar therapy for cerebral edema

D. Hypothermia-induced vasodilation

5. In post–cardiac arrest patients with AKI, CRRT is preferred over IRRT/PIRRT mainly because:

A. It enhances urea clearance

B. It minimizes cerebral edema and maintains autoregulation

C. It requires less anticoagulation

D. It reduces the risk of filter clotting

6. Optimal fluid management on VA ECMO during post–cardiac arrest care involves:

A. Liberal fluid resuscitation to optimize preload

B. Relying solely on central venous pressure (CVP) to guide therapy

C. Multimodal assessment using POCUS and hemodynamic monitoring with fluid-conservative goals

D. Strict adherence to fluid restriction regardless of hemodynamics

7. The use of left ventricular venting strategies such as IABP or Impella during VA ECMO:

A. Has been shown to directly improve renal perfusion

B. Carries an increased procedural and hemodynamic risk of AKI

C. Eliminates the need for vasopressor support

D. Reduces systemic inflammation and AKI risk

8. During the de-resuscitation phase on VA ECMO with concurrent CRRT, fluid removal should be:

A. Fixed at 1.5 mL/kg/hr for all patients

B. Aggressively targeted without hemodynamic consideration

C. Individualized to balance perfusion, prevent ECMO chatter, and maintain right heart preload

D. Delayed until ECMO weaning is complete

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💔 Post-Cardiac Arrest AKI on VA-ECMO: When the Heart Restarts but the Kidneys Struggle 💧

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