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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

  • Leitlinien
  • Published:
Der Kardiologe Aims and scope

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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Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Heinrich Heine University Medical School, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    Udo Boeken & Alexander Assmann

  2. Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Deutschland

    Stephan Ensminger

  3. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Deutschland

    Christof Schmid

  4. Clinic for Internal Medicine III, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle-Wittenberg, Deutschland

    Karl Werdan

  5. Department of Acute and Emergency Care, St Antonius Hospital Eschweiler, Eschweiler, Deutschland

    Guido Michels

  6. Department of Congenital Heart Disease–Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Oliver Miera

  7. Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Deutschland

    Florian Schmidt

  8. Department of Cardiac Surgery, Segeberger Kliniken, Bad Segeberg, Deutschland

    Stefan Klotz

  9. Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Deutschland

    Christoph Starck

  10. Imland Hospital Rendsburg, Department for Intensive Care Medicine, Rendsburg, Schleswig-Holstein, Deutschland

    Kevin Pilarczyk & Nils Haake

  11. Department of Cardiac and Vascular Thoracic Surgery, Philipps University Hospital Marburg, Marburg, Deutschland

    Ardawan Rastan

  12. Department of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University (DHBW)–Stuttgart, Stuttgart, Deutschland

    Marion Burckhardt

  13. Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Deutschland

    Monika Nothacker

  14. Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Deutschland

    Ralf Muellenbach

  15. Department of Anesthesiology and Operative Intensive Care Medicine, Aschaffenburg-Alzenau Hospital, Aschaffenburg, Bavaria, Deutschland

    York Zausig

  16. Department of Intensive Care Medicine, Helios Clinic Erfurt, 99089, Erfurt, Deutschland

    Heinrich Groesdonk

  17. HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden, Deutschland

    Markus Ferrari

  18. Department of Cardiology, Angiology and Internal Intensive Care Medicine, St. Marienkrankenhaus Siegen, Siegen, Deutschland

    Michael Buerke

  19. Department of Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine, SLK-Kliniken Heilbronn, Heilbronn, Deutschland

    Marcus Hennersdorf

  20. Department of Internal Medicine I, Hospital Aschaffenburg-Alzenau, Aschaffenburg-Alzenau, Deutschland

    Mark Rosenberg

  21. Department of Neonatology, University Children’s Hospital Mannheim, University of Heidelberg, Mannheim, Deutschland

    Thomas Schaible

  22. Medical University Children’s Hospital, Hannover, Deutschland

    Harald Köditz

  23. Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland

    Stefan Kluge

  24. Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Deutschland

    Uwe Janssens

  25. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Deutschland

    Matthias Lubnow

  26. Division of Neonatology, Dr. v. Hauner Children’s Hospital and Perinatal Center Munich–Grosshadern, LMU Munich, Munich, Deutschland

    Andreas Flemmer

  27. Division of Neonatology, Dr. v. Hauner Children’s Hospital and Perinatal Center Munich–Grosshadern, LMU Munich, Munich, Deutschland

    Susanne Herber-Jonat

  28. Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Deutschland

    Lucas Wessel

  29. Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr University, Bochum, Deutschland

    Dirk Buchwald

  30. Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Deutschland

    Sven Maier

  31. Division of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University, Bochum, Deutschland

    Lars Krüger

  32. Department of Physiotherapy, Heart and Diabetes Center NRW, Ruhr University, Bochum, Bochum, Deutschland

    Andreas Fründ

  33. German Heart Foundation, Frankfurt am Main, Deutschland

    Rolf Jaksties

  34. Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Deutschland

    Stefan Fischer

  35. Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Deutschland

    Karsten Wiebe

  36. Department of Anesthesiology and Operative Intensive Care Medicine, Charité, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland

    Christiane Hartog

  37. Department of Cardiac Surgery, Triemli City Hospital Zurich, Birmensdorferstraße 497, 8063, Zurich, Schweiz

    Omer Dzemali

  38. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Österreich

    Daniel Zimpfer

  39. Department of Cardiac Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    Elfriede Ruttmann-Ulmer

  40. Department of Cardiothoracic and Vascular Surgery, University of Tübingen, Tübingen, Deutschland

    Christian Schlensak

  41. Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Medical School, Moorenstraße 5, Duesseldorf, Deutschland

    Malte Kelm

  42. German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Luisenstraße 58/59, Berlin, Deutschland

    Andreas Beckmann

Authors
  1. Udo Boeken
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  2. Stephan Ensminger
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  3. Alexander Assmann
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  4. Christof Schmid
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  7. Oliver Miera
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  8. Florian Schmidt
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  13. Marion Burckhardt
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  19. Markus Ferrari
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  30. Lucas Wessel
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  36. Stefan Fischer
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  37. Karsten Wiebe
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  38. Christiane Hartog
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  39. Omer Dzemali
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  40. Daniel Zimpfer
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  41. Elfriede Ruttmann-Ulmer
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  42. Christian Schlensak
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  43. Malte Kelm
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  44. Andreas Beckmann
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Corresponding author

Correspondence to Udo Boeken.

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Ausführliche Angaben aller Autor*innen zum Interessenkonflikt finden Sie im Onlinezusatzmaterial des Beitrags.

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

Additional information

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.

Der Verlag veröffentlicht die Beiträge in der von den Autor*innen gewählten Genderform. Die Verwendung einer angemessenen gendergerechten Sprache, um Menschen in ihrer Viefalt wertschätzend anzusprechen, wird begrüßt.

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Boeken, U., Ensminger, S., Assmann, A. et al. Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen. Kardiologe 15, 526–535 (2021). https://doi.org/10.1007/s12181-021-00514-4

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