Skip to main content
SpringerLink
Log in

Extrakorporale Lungenunterstützungsverfahren

Extracorporeal lung support

  • CME Zertifizierte Fortbildung
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Verfahren zur extrakorporalen Lungenunterstützung, wie die extrakorporale Membranoxygenierung (ECMO), ermöglichen es seit Jahrzehnten in spezialisierten Zentren, die Funktion der schwer geschädigten Lunge ganz oder teilweise zu übernehmen und somit eine Ausheilung zu ermöglichen. War die Anwendung anfänglich noch mit schwerwiegenden Komplikationen behaftet, führte der enorme technische Fortschritt zur Entwicklung sichererer ECMO-Systeme und förderte die Verbreitung der Methode. Unterstützt durch positive Studiendaten etabliert sich in den letzten Jahren mit der ECMO eine neue ernst zu nehmende Säule der ARDS-Therapie (ARDS: „acute respiratory distress syndrome“) in spezialisierten Zentren. Weiterentwicklungen und Modifikationen, wie Systeme zur pumpenfreien extrakorporalen Lungenunterstützung, haben ferner das Potenzial, künftig interessante Optionen für den Einsatz in der Intensivmedizin zu bieten – Ergebnisse prospektiver Studien, welche deren Effektivität belegen, stehen aber noch aus.

Abstract

For decades, techniques for extracorporeal lung support, such as extracorporeal membrane oxygenation (ECMO), have offered in specialized centres the possibility to completely or partly substitute lung function, thus, facilitating healing. Initially the application of ECMO was associated with severe complications, but significant technical progress in recent years has led to the development of safer systems and promotes a wider distribution of the technique. Supported by recent, positive study data, ECMO has become a promising option for acute respiratory distress syndrome (ARDS) therapy in specialized centers. Further developments and modifications, such as pumpless devices for extracorporeal lung support have the potential of becoming an interesting option for intensive care medicine – however, data of prospective studies showing efficacy are still not available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Abbreviations

ACT:

„Activated clotting time“

ARDS:

„Acute respiratory distress syndrome“

CESAR:

„Conventional ventilation or ECMO for severe adult respiratory failure“

CK:

Kreatinkinase

COPD:

Chronische obstruktive Lungenerkrankung

ECMO:

„Extracorporeal membrane oxygenation“

ELSO :

„Extracorporeal Life Support Organization“

FiO2 :

Fraktion des Sauerstoffs im Einatemgemisch

iLA :

„Interventional lung assist device“

paO2 :

Arterieller Sauerstoffpartialdruck

PAVK:

Periphere arterielle Verschlusskrankheit

PEEP:

Positiver endexspiratorischer Druck

PTT :

Partielle Thromboplastinzeit

va-ECMO:

Venoarterielle extrakorporale Membranoxygenierung

vv-ECMO :

Venovenöse extrakorporale Membranoxygenierung

Literatur

  1. Bermudez CA, Adusumilli PS, Mccurry KR et al (2009) Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: long-term survival. Ann Thorac Surg 87:854–860

    Article  PubMed  Google Scholar 

  2. Cordell-Smith JA, Roberts N, Peek GJ et al (2006) Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury 37:29–32

    Article  PubMed  CAS  Google Scholar 

  3. Thalmann M, Trampitsch E, Haberfellner N et al (2001) Resuscitation in near drowning with extracorporeal membrane oxygenation. Ann Thorac Surg 72:607–608

    Article  PubMed  CAS  Google Scholar 

  4. Hecker M, Walmrath HD, Seeger W et al (2008) Clinical aspects of acute lung insufficiency (ALI/TRALI). Transfus Med Hemother 35:80–88

    Article  PubMed  Google Scholar 

  5. Hecker M, Weigand MA, Mayer K (2012) Acute respiratory distress syndrome. Internist (Berl) 53:557–566

    Google Scholar 

  6. Wildschut ED, Ahsman MJ, Allegaert K et al (2011) Determinants of drug absorption in different ECMO circuits. Intensive Care Med 36:2109–2116

    Article  Google Scholar 

  7. Hill JD, O’Brien TG, Murray JJ et al (1972) Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 286:629–634

    Article  PubMed  CAS  Google Scholar 

  8. Zapol WM, Snider MT, Hill JD et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196

    Article  PubMed  CAS  Google Scholar 

  9. Morris AH, Wallace CJ, Menlove RL et al (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 149:295–305

    PubMed  CAS  Google Scholar 

  10. Peek GJ, Mugford M, Tiruvoipati R et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363

    Article  PubMed  Google Scholar 

  11. Davies A, Jones D, Bailey M et al (2009) Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 302:1888–1895

    Article  PubMed  CAS  Google Scholar 

  12. Reng M, Philipp A, Kaiser M et al (2000) Pumpless extracorporeal lung assist and adult respiratory distress syndrome. Lancet 356:219–220

    Article  PubMed  CAS  Google Scholar 

  13. Hecker M, Weigand MA, Mayer K (2012) Akute respiratorische Insuffizienz. Internist 53:557–566

    Article  PubMed  CAS  Google Scholar 

  14. Moerer O, Quintel M (2011) Protective and ultra-protective ventilation: using pumpless interventional lung assist (iLA). Minerva Anestesiol 77:537–544

    PubMed  CAS  Google Scholar 

  15. Elliot SC, Paramasivam K, Oram J et al (2007) Pumpless extracorporeal carbon dioxide removal for life-threatening asthma. Crit Care Med 35:945–948

    Article  PubMed  Google Scholar 

  16. Bein T, Weber F, Philipp A et al (2006) A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med 34:1372–1377

    Article  PubMed  Google Scholar 

  17. Zimmermann M, Bein T, Arlt M et al (2009) Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Crit Care 13:R10

    Article  PubMed  Google Scholar 

  18. Fuehner T, Kuehn C, Hadem J et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–768

    Article  PubMed  Google Scholar 

  19. Olsson KM, Simon A, Strueber M et al (2010) Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant 10:2173–2178

    Article  PubMed  CAS  Google Scholar 

  20. Chen YS, Lin JW, Yu HY et al (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372:554–561

    Article  PubMed  Google Scholar 

  21. Chung SY, Sheu JJ, Lin YJ et al (2012) Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. Circ J 76(6):1385–1392

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Medizinische Klinik II (Pneumologie/internistische Intensivmedizin), Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    M. Hecker & D. Bandorski

  2. Klinik für Allgemein-, Viszeral-, Thorax- und Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    A. Hecker

Authors
  1. M. Hecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Bandorski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Hecker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Hecker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hecker, M., Bandorski, D. & Hecker, A. Extrakorporale Lungenunterstützungsverfahren. Med Klin Intensivmed Notfmed 107, 491–501 (2012). https://doi.org/10.1007/s00063-012-0142-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-012-0142-x

Schlüsselwörter

Keywords

Search

Navigation