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Patienten unter Reanimation: Kandidaten für „Extracorporeal Life Support“?

Patients undergoing cardiopulmonary resuscitation: Candidates for Extracorporeal Life Support?

  • Kardiotechnik/EKZ
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Der konventionell therapierefraktäre Herz-Kreislauf-Stillstand verläuft in aller Regel letal. Die „Extracorporeal Life Support“(ECLS)-Therapie hat das Potenzial der sofortigen, vollen kardiopulmonalen Unterstützung und wird zunehmend im Rahmen der kardiopulmonalen Reanimation (Extracorporeal Cardiopulmonary Resuscitation, ECPR) eingesetzt.

Fragestellung

Diese Arbeit soll Einblicke in die aktuelle Studienlage und eine Übersicht über das Verfahren der ECPR geben.

Material und Methoden

Es erfolgt ein systematischer Überblick über die vorhandenen Daten und Empfehlungen zur ECPR-Therapie in Kombination mit einer fokussierten Darstellung von Schlüsselelementen des Verfahrens.

Ergebnisse

Die ECPR kann im Fall der frustranen konventionellen CPR zur Etablierung einer suffizienten Zirkulation dienen. Daten aus prospektiven, randomisierten kontrollierten Studien sind bisher nicht verfügbar. Es handelt sich um ein hochinvasives Verfahren, das entsprechende Expertise erfordert. Parameter zur Patienten-Triage können Alter und Vorerkrankungen, den beobachteten Herz-Kreislauf-Stillstand, die Ischämiezeit, Qualität und Dauer der Reanimation, einschließlich Einsatz einer mechanischen Kompressionshilfe, umfassen. Vor Implantation liefern pH-Wert und Lactatkonzentration wertvolle Zusatzinformationen über den metabolischen Zustand des Patienten und die Perfusion während der Reanimation.

Schlussfolgerung

Das Verfahren der ECPR sollte auf Zentren der Maximalversorgung beschränkt sein, die über das volle Spektrum der modernen interdisziplinären Herzmedizin verfügen, einschließlich Kunstherzimplantation und thorakaler Organtransplantation. Randomisierte kontrollierte Studien und umfassende entsprechende Leitlinien sind dringend erforderlich. Die Definition minimaler Fallzahlen und die Etablierung von Kompetenzzentren werden zu diskutieren sein.

Abstract

Background

Conventionally therapy-refractory cardiac arrest usually has a fatal outcome. Extracorporeal life support (ECLS) has the potential to provide immediate full cardiopulmonary support and becomes increasingly implemented in the setting of cardiopulmonary resuscitation (Extracorporeal Cardiopulmonary Resuscitation, ECPR).

Objective

This article aims to provide insights into current study results and a synopsis of the technique of ECPR.

Material and methods

This article gives a systematic overview of available data and recommendations in combination with a focused presentation of key elements of ECPR.

Results

In the setting of unsuccessful conventional cardiopulmonary resuscitation, ECPR can be used to establish a sufficient circulation. No data from prospective, randomized controlled trials are currently available. It is a highly invasive technique that requires substantial expertise. Parameters that may assist in triaging the patients include age, comorbidities, witnessed cardiac arrest, ischemia time, quality and duration of resuscitation and use of mechanical chest compression devices. Preimplantation pH and lactate levels provide valuable additional information on the metabolic status and perfusion during resuscitation.

Conclusion

The use of ECPR should be limited to centers of maximum care providing the full spectrum of modern interdisciplinary cardiac medicine, including ventricular assist device implantation and thoracic organ transplantation. Randomized controlled trials and comprehensive guidelines are urgently needed. The definition of minimum case numbers and the establishment of competence centers need to be discussed.

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Danksagung

Die Autoren danken Herrn Andreas Steeger für das Erstellen des in Abb. 1 und 2 verwendeten Fotomaterials.

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Authors and Affiliations

  1. Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland

    S. P. W. Günther, F. Born, S. Buchholz, R. Schramm, A. M. Pichlmaier & C. Hagl

  2. Klinik für Anaesthesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland

    V. von Dossow

  3. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland

    S. Brunner & S. Massberg

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Correspondence to S. P. W. Günther.

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Interessenkonflikt

S.P.W. Günther, F. Born, S. Buchholz, V. von Dossow, R. Schramm, S. Brunner, S. Massberg, A.M. Pichlmaier und C. Hagl geben an, dass kein Interessenkonflikt besteht.

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

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Günther, S.P.W., Born, F., Buchholz, S. et al. Patienten unter Reanimation: Kandidaten für „Extracorporeal Life Support“?. Z Herz- Thorax- Gefäßchir 32, 133–140 (2018). https://doi.org/10.1007/s00398-017-0199-1

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  • DOI: https://doi.org/10.1007/s00398-017-0199-1

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