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Extrakorporale Reanimation – wenn das Herz nicht mehr funktioniert

Extracorporeal cardiopulmonary resuscitation—When the heart no longer functions

  • Schwerpunkt: Neue Entwicklungen in der internistischen Intensivmedizin
  • Published:
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Zusammenfassung

Die extrakorporale Reanimation („extracorporeal cardiopulmonary resuscitation“ [ECPR]) ist eine Option zur Wiederherstellung des Kreislaufs bei Patienten mit refraktärem Kreislaufversagen. Unter Fortführung konventioneller Reanimationsmaßnahmen wird bei Patienten im Herz-Kreislauf-Stillstand eine venoarterielle extrakorporale Membranoxygenierung (VA ECMO) etabliert, die als Bypass die Funktionen von Herz und Lunge bis zur Erholung der Organe kompensieren kann. Im Vergleich zur konventionellen Reanimation besteht ein Vorteil für die ECPR am ehesten insbesondere nach längerer Reanimationszeit, jedoch konnte bisher in drei prospektiven randomisierten, kontrollierten Studien kein Vorteil für den allgemeinen Einsatz belegt werden. Aufbau und Betrieb eines ECPR-Systems sind komplex und ressourcenintensiv, daher sollte der Einsatz auf spezialisierte Zentren mit ausreichenden Patientenzahlen begrenzt sein, um eine hohe Expertise der Teams zu gewährleisten.

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for restoring blood circulation in patients with refractory circulatory failure. While conventional resuscitation measures are being continued, venoarterial extracorporeal membrane oxygenation (VA ECMO) is established in patients with cardiac arrest. This bypass can compensate for the functions of the heart and lungs until recovery of organ function. The benefit of ECPR compared to conventional resuscitation appears to be evident, especially after a prolonged resuscitation period; however, in three prospective randomized controlled studies an advantage has not yet been conclusively proven for widespread use in clinical routine. ECPR systems are complex and resource-intensive and should therefore be limited to specialized centers where sufficient numbers of patients are treated to ensure a high level of expertise in the teams.

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Authors and Affiliations

  1. Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    A. Supady MPH &  T. Wengenmayer

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  1. A. Supady MPH
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  2. T. Wengenmayer
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Correspondence to A. Supady MPH.

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A. Supady und T. Wengenmayer sind als Referenten für die Firmen Getinge, Fresenius und Resuscitec tätig.

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

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Michael Hallek, Köln

Matthias Kochanek, Köln

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Supady, A., Wengenmayer, T. Extrakorporale Reanimation – wenn das Herz nicht mehr funktioniert. Innere Medizin 64, 913–921 (2023). https://doi.org/10.1007/s00108-023-01587-x

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