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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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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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  • DOI: https://doi.org/10.1007/s00063-019-0533-3

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