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Indikationen und Grenzen der ECMO-Therapie

Überlegungen zur Evidenz, Therapieentscheidung und ethischen Herausforderung

Indications and limitations of ECMO therapy

Considerations on evidence, treatment decisions and ethical challenges

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Zusammenfassung

Die vorliegende Arbeit beleuchtet die Möglichkeiten und Grenzen der modernen extrakorporalen Membranoxygenierung (ECMO) bei Herz- oder Lungenversagen. Da die Zahl der Anwendungen von extrakorporalen Lungen- und Herz‑/Lungenersatzverfahren in den letzten Jahren bei schwerstkranken Patienten dramatisch zugenommen hat, ist die Entscheidungsfindung zur sinnvollen Indikation und im Verlauf einer eventuellen Therapiezieländerung besonders schwierig geworden, besonders auch im Hinblick auf die komplexe Situation in der Organtransplantation in Deutschland. Es wird versucht, das Dilemma zwischen Daten aus großen kontrollierten Studien und epidemiologischen Untersuchungen und der Entscheidung beim individuellen Patienten näher zu beleuchten.

Abstract

The present work sheds light on the possibilities and limitations of modern extracorporeal membrane oxygenation (ECMO) therapy in the case of heart or lung failure. Since the number of applications of extracorporeal lung and heart/lung replacement procedures has increased dramatically in the last few years in severely ill patients, decision-making for a meaningful indication and in the course of a possible therapy target change has become particularly difficult, especially with regard to the complex situation in organ transplantation in Germany. An attempt is made to elucidate the dilemma between data from large controlled trials and epidemiological studies and the patients’ individuality.

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Literatur

  1. Ahn C, Kim W, Cho Y et al (2016) Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: A systematic review and meta-analysis. Sci Rep 6:34208

    Article  CAS  Google Scholar 

  2. Bein T, Weber-Carstens S, Goldmann A et al (2013) Lower tidal volume strategy (approximately 3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDS: The prospective randomized Xtravent-study. Intensive Care Med 39:847–856

    Article  Google Scholar 

  3. Bein T, Weber-Carstens S, Herridge M (2015) Extracorporeal life support, ethics, and questions at the bedside: How does the end of the pathway look? Intensive Care Med 41:1714–1715

    Article  Google Scholar 

  4. Braune S, Sieweke A, Brettner F et al (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 42:1437–1444

    Article  CAS  Google Scholar 

  5. Combes A, Brechot N, Luyt CE et al (2018) Indications for extracorporeal support: Why do we need the results of the EOLIA trial? Med Klin Intensivmed Notfmed 113:21–25

    Article  CAS  Google Scholar 

  6. Combes A, Slutsky AS, Brodie D (2018) ECMO for severe acute respiratory distress syndrome. N Engl J Med 379:1091–1092

    PubMed  Google Scholar 

  7. Del Sorbo L, Fan E, Nava S et al (2016) ECCO2R in COPD exacerbation only for the right patients and with the right strategy. Intensive Care Med 42:1830–1831

    Article  Google Scholar 

  8. Del Sorbo L, Pisani L, Filippini C et al (2015) Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: A matched cohort study with historical control. Crit Care Med 43:120–127

    Article  Google Scholar 

  9. Fried TR, Bradley EH, Towle VR et al (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061–1066

    Article  Google Scholar 

  10. Huttmann SE, Magnet FS, Karagiannidis C et al (2018) Quality of life and life satisfaction are severely impaired in patients with long-term invasive ventilation following ICU treatment and unsuccessful weaning. Ann Intensive Care 8:38

    Article  Google Scholar 

  11. Huttmann SE, Windisch W, Storre JH (2015) Invasive home mechanical ventilation: Living conditions and health-related quality of life. Respiration 89:312–321

    Article  Google Scholar 

  12. Janssens U, Burchardi H, Duttge G, Erchinger R, Gretenkort P, Mohr M, Nauck F, Rothärmel S, Salomon F, Schmucker P, Simon A, Stopfkuchen H, Valentin A, Weiler N, Neitzke G (2012) Therapiezieländerung und Therapiebegrenzung in der Intensivmedizin. Medizinrecht 3ß(10):647–650. https://doi.org/10.1007/s00350-012-3247-6 (Positionspapier der Sektion Ethik der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin)

    Article  Google Scholar 

  13. Karagiannidis C (2018) EOLIA trial: Does ECMO confer a survival advantage in ARDS? Med Klin Intensivmed Notfmed. https://doi.org/10.1007/s00063-018-0511-1

    Article  PubMed  Google Scholar 

  14. Karagiannidis C, Brodie D, Strassmann S et al (2016) Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med 42:889–896

    Article  CAS  Google Scholar 

  15. Karagiannidis C, Kampe KA, Sipmann FS et al (2014) Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: Pathophysiological and technical considerations. Crit Care 18:R124

    Article  Google Scholar 

  16. Karagiannidis C, Strassmann S, Callegari J et al (2018) Evolving epidemiology of home mechanical ventilation: A rapidly growing challenge for patient care. Dtsch Med Wochenschr. https://doi.org/10.1055/a-0758-4512

    Article  PubMed  Google Scholar 

  17. Karagiannidis C, Windisch W (2016) Epidemiology and mortality of extracorporeal life support in Germany between 2007 and 2014. Med Klin Intensivmed Notfmed 111:556–559

    Article  CAS  Google Scholar 

  18. Miller LW, Rogers JG (2018) Evolution of left ventricular assist device therapy for advanced heart failure: A review. JAMA Cardiol 3:650–658

    Article  Google Scholar 

  19. Ortega-Deballon I, Hornby L, Shemie SD et al (2016) Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: A systematic review of international practices and outcomes. Resuscitation 101:12–20

    Article  Google Scholar 

  20. Peek GJ, Mugford M, Tiruvoipati R et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial. Lancet 374:1351–1363

    Article  Google Scholar 

  21. Rahmel A (2018) Organ donation. Med Klin Intensivmed Notfmed. https://doi.org/10.1007/s00063-018-0513-z

    Article  PubMed  Google Scholar 

  22. Sauer CM, Yuh DD, Bonde P (2015) Extracorporeal membrane oxygenation use has increased by 433 % in adults in the United States from 2006 to 2011. ASAIO J 61:31–36

    Article  CAS  Google Scholar 

  23. Schulte K, Borzikowsky C, Rahmel A et al (2018) Decline in organ donation in Germany. Dtsch Arztebl Int 115:463–468

    PubMed  PubMed Central  Google Scholar 

  24. Fichtner F, Moerer O, Laudi S, Weber-Carstens S, Nothacker M, Kaisers U (2018) Beatmungstherapie und Extrakorporalverfahren bei akuter respiratorischer Insuffizienz. Dtsch Arztebl Int 115(50):840–847. https://doi.org/10.3238/arztebl.2018.0840 (Klinische Leitlinie)

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. ARDS und ECMO Zentrum, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Ostmerheimer Straße 200, 51109, Köln, Deutschland

    C. Karagiannidis

  2. Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Regensburg, Regensburg, Deutschland

    T. Bein

  3. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité – Universitätsmedizin Berlin, „corporate member“ der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland

    S. Weber-Carstens

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  1. C. Karagiannidis
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  2. T. Bein
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  3. S. Weber-Carstens
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Corresponding author

Correspondence to C. Karagiannidis.

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Interessenkonflikt

C. Karagiannidis, T. Bein und S. Weber-Carstens geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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U. Janssens, Eschweiler

W. Druml, Wien

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Karagiannidis, C., Bein, T. & Weber-Carstens, S. Indikationen und Grenzen der ECMO-Therapie. Med Klin Intensivmed Notfmed 114, 207–213 (2019). https://doi.org/10.1007/s00063-019-0533-3

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