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Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen

Kurzversion der AWMF-S3-Leitlinie

Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure

Short version of the S3 guideline

Zusammenfassung

Seit einigen Jahren ist eine stetige Zunahme des Einsatzes von mechanischen extrakorporalen Herz-Kreislauf- und Lungenunterstützungssystemen (ECLS/ECMO) zu verzeichnen. So wurden seit 2015 in Deutschland jährlich bei etwa 3000 Patienten ECLS/ECMO-Systeme implantiert. Trotz dieser häufigen Anwendung der passageren Unterstützungssysteme existieren zurzeit national und international nur Leitlinien zum Einsatz der ECMO/ECLS, die erkrankungsbezogene Teilaspekte komplexer Therapiekaskaden adressieren. Vor diesem Hintergrund erschien es notwendig, evidenzbasierte Empfehlungen zur ECLS/ECMO-Therapie im Hinblick auf Indikationen und das komplexe Patientenmanagement zu verfassen, in denen personelle, prozessuale und infrastrukturelle Anforderungen definiert werden. Aus diesem Grund erfolgte im Juli 2015 durch die Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) die Anmeldung einer diesbezüglichen S3-Leitlinie bei der zuständigen Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF). Im Mittelpunkt der Leitlinie steht die klinische Anwendung der ECLS/ECMO-Therapie; ergänzend werden auch strukturelle und ökonomische Aspekte adressiert. Unter Federführung der DGTHG wurde mit Einbindung von Experten aus Deutschland, Österreich und der Schweiz, delegiert aus 11 AWMF-Fachgesellschaften, 5 weiteren Fachgesellschaften sowie der Patientenvertretung, die S3-Leitlinie im Februar 2021 publiziert. Dieser Artikel stellt eine kurze Zusammenfassung des methodischen Konzepts sowie aller konsentierten Empfehlungen für jede bearbeitete Fragestellung der Leitlinie dar.

Abstract

In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline “Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure” to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients’ organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline.

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Dieser Beitrag erscheint parallel in den Zeitschriften Der Anaesthesist, Der Kardiologe, Medizinische Klinik – Intensivmedizin und Notfallmedizin, Zeitschrift für Herz-, Thorax- und Gefäßchirurgie sowie Anästhesiologie & Intensivmedizin.

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Boeken, U., Ensminger, S., Assmann, A. et al. Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen. Med Klin Intensivmed Notfmed 116, 678–686 (2021). https://doi.org/10.1007/s00063-021-00868-3

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Schlüsselwörter

  • EKZ
  • ECLS
  • Herzinsuffizienz
  • Kardiomyopathie
  • Mechanische Kreislaufunterstützung
  • Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.

Keywords

  • ECC
  • ECLS
  • Cardiac failure
  • Cardiomyopathy
  • Mechanical circulatory support
  • Association of the Scientific Medical Societies in Germany