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Venoarterielle extrakorporale Membranoxygenierung (ECMO)

Einsatz bei fulminanter Lungenembolie

Arteriovenous extracorporeal membrane oxygenation (ECMO)

A therapeutic option for fulminant pulmonary embolism

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Zusammenfassung

Gemäß der Leitlinie der Europäischen (2008) und der Deutschen Gesellschaft für Kardiologie (2009) wird für Patienten mit einer Lungenembolie im kardiogenen Schock zunächst die thrombolytische Therapie (Empfehlungsgrad I, Evidenzgrad A) empfohlen. Ist die Lyse kontraindiziert oder nicht erfolgreich, kann eine chirurgische Embolektomie (Empfehlungsgrad I, Evidenzgrad C) erwogen werden. Als weitere Optionen aufgeführt werden eine Katheterembolektomie oder eine Fragmentation des Thrombus in der proximalen pulmonalen Arterie genannt (Empfehlungsgrad IIb, Evidenzgrad C). Der Einsatz der venoarteriellen extrakorporalen Membranoxygenierung (ECMO) bleibt in den genannten Leitlinien unerwähnt. Eine PubMed-Literaturrecherche ergibt einige Fallberichte über erfolgreiche Anwendung der venoarteriellen ECMO bei reanimationspflichtigen Lungenemboliepatienten, wenn die Lysetherapie versagt. Vorgestellt wird ein Patient, der unmittelbar nach einem operativen Eingriff eine fulminante Lungenembolie entwickelt hatte, sich unter Lysetherapie weiterhin im kardiogenen Schock befand und schließlich nach der Anlage einer venoarteriellen ECMO stabilisiert werden konnte. Bei einer fulminanten Lungenembolie steht das akute Herzversagen im Vordergrund. Es kommt konsekutiv zur Hypoxämie mit drohender Hypoxie lebenswichtiger Organe. Der Einsatz der venoarteriellen extrakorporalen Membranoxygenierung ist eine therapeutische Option bei lebensbedrohlicher Lungenembolie. Entscheidend für einen Erfolg ist die sofortige Indikationsstellung und zügige Implantation des Systems.

Abstract

According to the guidelines of the European (2008) and German Societies of Cardiology (2009) thrombolysis is recommended for patients with pulmonary embolisms presenting with cardiogenic shock (recommendation level I, evidence level A). If there are contraindications or thrombolysis is not successful surgical embolectomy should be considered (recommendation level I, evidence level C). Additional options are catheter-based therapies in the proximal pulmonary artery (recommendation level IIb, evidence level C). The use of arteriovenous extracorporeal membrane oxygenation ( ECMO) was not included in these guidelines. A literature search in PubMed resulted in some case reports of the successful use of arteriovenous ECMO for resuscitation in patients with severe pulmonary embolisms following failed thrombolysis. In this article we present the case report of a patient who developed fulminant pulmonary embolism immediately after surgery. The patient was still in cardiogenic shock despite thrombolysis but the condition was stable following implementation of an arteriovenous ECMO. Acute heart failure and hypoxemia of all organs are the main symptoms of massive pulmonary embolisms. The use of arteriovenous ECMO represents a therapeutic option for life-threatening pulmonary embolism. A decisive factor for success is immediate diagnosis and rapid implementation of the system.

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Authors and Affiliations

  1. Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    J. Swol & T.A. Schildhauer

  2. Klinik für Herz- und Thoraxchirurgie, Funktionsbereich Kardiotechnik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland

    D. Buchwald

  3. Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland

    A. Ewers

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  1. J. Swol
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  2. D. Buchwald
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  3. A. Ewers
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  4. T.A. Schildhauer
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Correspondence to J. Swol.

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Swol, J., Buchwald, D., Ewers, A. et al. Venoarterielle extrakorporale Membranoxygenierung (ECMO). Med Klin Intensivmed Notfmed 108, 63–68 (2013). https://doi.org/10.1007/s00063-012-0164-4

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  • DOI: https://doi.org/10.1007/s00063-012-0164-4

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