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Empfehlungen zum Notfallmanagement von Patienten mit permanenten Herzunterstützungssystemen

Konsensuspapier der DGTHG, DIVI, DGIIN, DGAI, DGINA, DGfK und DGK

Recommendations for emergency management of patients with permanent mechanical circulatory support

Consensus statement of DGTHG, DIVI, DGIIN, DGAI, DGINA, DGfK and DGK

  • Konsensuspapiere
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

In den letzten Jahren ist aufgrund technischer Fortschritte mit einer Miniaturisierung der Systeme und Reduktion der postoperativen Komplikationen, Zunahme der Prävalenz der Herzinsuffizienz, dem Spendermangel im Bereich der Transplantation sowie steigender Lebenserwartung eine deutliche Zunahme der Patientenzahl mit permanenten Herzunterstützungssystemen zu verzeichnen. Dieses sehr spezielle Patientenkollektiv kann sowohl akute systemassoziierte Notfälle, wie z. B. Pumpenthrombose oder Device-Fehlfunktion, aber auch nichtsystemassoziierte Notfälle aufweisen. Aufgrund der Besonderheiten in der Physiologie sowie potenzieller systembezogener Komplikationen ist die Versorgung dieser Patienten in Notfallsituationen komplex. Nationale oder internationale Empfehlungen fehlen bisher. Das vorliegende Konsensuspapier bietet, basierend auf einer konsentierten Expertenmeinung, den Vorschlag für einen Algorithmus zur strukturierten und zügigen Evaluation von Notfällen bei Patienten mit permanenten Herzunterstützungssystemen sowie deren Management.

Abstract

The prevalence of patients living with long-term mechanical circulatory support (MCS) is rapidly increasing due to improved technology, improved survival, reduced adverse event profiles, greater reliability and mechanical durability, and limited numbers of organs available for donation. Patients with long-term MCS are very likely to require emergency medical support due to MCS-associated complications (e.g., right heart failure, left ventricular assist device malfunction, hemorrhage and pump thrombosis) but also due to non-MCS-associated conditions. Because of the unique characteristics of mechanical support, management of these patients is complicated and there is very little literature on emergency care for these patients. The purpose of this national scientific statement is to present consensus-based recommendations for the initial evaluation and resuscitation of adult patients with long-term MCS.

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Authors and Affiliations

  1. Klinik für Intensivmedizin, imland Klinik Rendsburg, Lilienstraße 22–28, 24768, Rendsburg, Deutschland

    Kevin Pilarczyk & Nils Haake

  2. Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Deutschland

    Udo Boeken

  3. Herzzentrum Duisburg, Klinik für Herz- und Gefäßchirurgie, Evangelisches Krankenhaus Niederrhein, Duisburg, Deutschland

    Andreas Beckmann

  4. Bendorf, Deutschland

    Andreas Markewitz

  5. Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena, Deutschland

    P. Christian Schulze

  6. Zentrale Notaufnahme, Florence Nightingale Krankenhaus, Düsseldorf, Deutschland

    Martin Pin

  7. Interdisziplinäres Notfallzentrum, Universitätsklinikum Bonn, Bonn, Deutschland

    Ingo Gräff

  8. Kerckhoff-Klinik, Bad Nauheim, Deutschland

    Sebastian Schmidt

  9. Klinik für Herzchirurgie und Thoraxchirurgie, Universitätsklinikum Jena, Jena, Deutschland

    Birk Runge

  10. Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland

    Hans-Jörg Busch

  11. Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Michael R. Preusch

  12. Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland

    Gereon Schälte

  13. Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland

    Jan Gummert

  14. Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland

    Guido Michels

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Correspondence to Kevin Pilarczyk or Guido Michels.

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Interessenkonflikt

G. Michels ist Sprecher der Arbeitsgruppe Kardiopulmonale Reanimation (AG42) und des Arbeitskreises Mechanische Kreislaufunterstützung der Arbeitsgruppe Interventionelle Kardiologie der Deutschen Gesellschaft für Kardiologie e. V. (DGK) sowie Mitglied der Arbeitsgruppe ECMO/eCPR des Deutschen Rates für Wiederbelebung e. V./German Resuscitation Council (GRC) und erhielt Honorare für Vortragstätigkeiten von den Firmen Zoll, Getinge, Sedana Medical und Orion Pharma. Die Interessenkonflikte stehen in keinem Zusammenhang mit der vorliegenden Arbeit. K. Pilarczyk, U. Boeken, A. Beckmann, A. Markewitz, P. C. Schulze, M. Pin, I. Gräff, S. Schmidt, B. Runge, H.-J. Busch, M.R. Preusch, N. Haake, G. Schälte und J. Gummert geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dieses Konsensuspapier wurde parallel in den Zeitschriften Medizinische Klinik – Intensivmedizin und Notfallmedizin, Der Kardiologe, Der Anästhesist und in der Zeitschrift für Herz‑, Thorax- und Gefäßchirurgie veröffentlicht.

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Pilarczyk, K., Boeken, U., Beckmann, A. et al. Empfehlungen zum Notfallmanagement von Patienten mit permanenten Herzunterstützungssystemen. Kardiologe 14, 168–181 (2020). https://doi.org/10.1007/s12181-020-00391-3

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