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Aktuelle Entwicklungen in der ECMO-/ECLS-Therapie bei Herz- und Kreislaufversagen

Current trends in ECMO/ECLS treatment for cardiac and circulatory failure

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

Zusammenfassung

Der Einsatz extrakorporaler Unterstützungsverfahren bei Herz- und Kreislaufversagen hat in den letzten Jahren, insbesondere auch im Kontext der SARS-CoV-2-Pandemie, erheblich zugenommen. Die klinischen Erfahrungen und empfohlenen Vorgehensweisen, im Sinne der „best practice“, entwickeln sich entsprechend weiter. Viele Patient*innen profitieren von einer ECMO-/ECLS-Therapie und können bestenfalls ohne gravierende Einschränkungen sowie mit entsprechender Lebensqualität wieder in ihren Alltag zurückkehren. Die Therapie mit ECMO/ECLS ist jedoch eine komplexe und invasive Behandlungsoption, die mit potenziellen Risiken für Komplikationen einhergeht, welche nicht unterschätzt werden dürfen. Diverse Fragen bezüglich der optimalen Vorgehensweise bei ECMO-/ECLS-Therapien sind gegenwärtig noch nicht wissenschaftlich beantwortet. Sowohl in der klinischen Praxis wie auch in der Forschung werden diverse Fragestellungen verfolgt, um die Letalität und Morbidität der betroffenen Patient*innen zu reduzieren. In diesem Kontext erscheinen die nachfolgenden Aspekte von besonderer Relevanz: Antikoagulation, Kanülierungs‑/Dekanülierungsstrategien, Therapie bei linksventrikulärer Distension und der Stellenwert des Calcium-Sensitizers Levosimendan beim Weaning. Im Folgenden werden auf Grundlage klinischer Erfahrungen aus drei herzchirurgischen Fachabteilungen, die regelmäßig ECMO-/ECLS-Therapien durchführen, fokussiert wichtige Entwicklungen aus dem klinischen Alltag dargestellt und wo möglich bewertet.

Abstract

The use of extracorporeal circulatory support procedures (ECMO/ECLS) for cardiovascular failure has significantly increased in recent years, especially in the context of the SARS-CoV‑2 pandemic. Clinical experience and best practices continue to evolve accordingly. Many patients benefit from ECMO/ECLS treatment and can return to their everyday lives with a good quality of life without significant restrictions. Treatment with ECMO/ECLS is, however, complex and invasive, and comes with the risk of potential complications that should not be underestimated. Various elements of the optimal procedure for ECMO/ECLS treatment have not yet been conclusively answered from a scientific standpoint. Several questions are therefore being pursued both in clinical practice and in research to reduce the mortality and morbidity of the affected patients. In this context, the following aspects appear to be of particular relevance: anticoagulation, cannulation and decannulation strategies, treatment for left ventricular distension and the role of the calcium sensitizer levosimendan for weaning. In the following, important developments from everyday clinical practice are presented and, wherever possible, evaluated on the basis of clinical experience from three cardiac surgery departments that regularly carry out ECMO/ECLS treatment.

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Authors and Affiliations

  1. Klinik für Herzchirurgie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    F. S. Jenkins, A. Assmann & U. Boeken

  2. Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Deutschland

    S. Ensminger

  3. Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Luisenstr. 58/59, Berlin, Deutschland

    A. Beckmann

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Correspondence to U. Boeken.

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Interessenkonflikt

F.S. Jenkins, A. Assmann, S. Ensminger, A. Beckmann und U. Boeken geben an, dass kein Interessenkonflikt besteht.

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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Jenkins, F.S., Assmann, A., Ensminger, S. et al. Aktuelle Entwicklungen in der ECMO-/ECLS-Therapie bei Herz- und Kreislaufversagen. Z Herz- Thorax- Gefäßchir 37, 224–230 (2023). https://doi.org/10.1007/s00398-023-00594-2

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