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Extrakorporale Membranoxygenierung beim akuten Lungenversagen

  • Intensivmedizin
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Zusammenfassung

Die extrakorporale Membranoxygenierung (ECMO) stellt heute im Rahmen klinischer Algorithmen einen wichtigen Baustein in der Therapie des schweren akuten Lungenversagens (ARDS) dar, nachdem sich in observationellen Studien der Wert dieses Verfahrens für die ARDS-Therapie trotz fehlender positiver kontrollierter Studien gezeigt hat. In spezialisierten Zentren wird bei Patienten mit drohender Hypoxie nach Anwendung verschiedener konservativer Therapieverfahren die ECMO unter Integration von Blutpumpen und künstlichen Membranlungen (Oxygenatoren) als Lungenersatzverfahren angewandt. Die Neuentwicklung von Oberflächenbeschichtungen, optimierten Oxygenatoren und miniaturisierten Blutpumpen sollte in der Zukunft sowohl die Hämokompatibilität steigern als auch die klinische Anwendung vereinfachen und komplikationsärmer machen. Die Entwicklung von Oxygenatoren mit deutlich niedrigeren Strömungswiderständen ermöglicht dabei die klinische Anwendung als pumpenloses, durch die arteriovenöse Druckdifferenz getriebenes Lungenunterstützungsverfahren (ECLA). Diese Neuentwicklungen könnten in der Zukunft zur Anwendung der ECMO nicht mehr nur als „ultima ratio“, sondern auch bei weniger schwerem ARDS führen, um lungenprotektivere, weniger invasive Beatmungsformen zu ermöglichen.

Abstract

After various observational studies demonstrated a benefit of extracorporeal membrane oxygenation (ECMO) in the therapy of severe acute respiratory distress syndrome (ARDS), ECMO now represents an important contribution for ARDS therapy using clinical algorithms despite a lack of positive controlled studies. In specialized centers patients with severe ARDS and imminent hypoxia despite intensive conventional therapy, are treated with ECMO using blood pumps and artificial membrane lungs (oxygenators) for extracorporeal lung assist. The development of new surface modifications, optimized oxygenators and miniaturized blood pumps should increase hemocompatibility and lead to simplified treatment as well as less complications. New oxygenators with significantly decreased blood resistance allow the clinical application of pumpless arteriovenous extracorporeal lung assist (ECLA). After these new developments indications for ECMO could be extended from use not only as ultima ratio but to less severe ARDS to enable lung protective, less invasive mechanical ventilation.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen

    R. Kopp, D. Henzler, R. Dembinski & R. Kuhlen

  2. Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074 , Aachen

    R. Kopp

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  1. R. Kopp
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  2. D. Henzler
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  3. R. Dembinski
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  4. R. Kuhlen
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Corresponding author

Correspondence to R. Kopp.

Anhang: ARDS-Zentren mit der Möglichkeit der ECMO-Therapie

Anhang: ARDS-Zentren mit der Möglichkeit der ECMO-Therapie

  • Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelstraße 30, 52074 Aachen

  • Klinik für Anästhesiologie und operative Intensivmedizin, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin

  • Anästhesiologische Universitätsklinik Freiburg, Hugstetter Straße 55, 79106 Freiburg

  • Zentrum für Anästhesie, Rettungs- und Intensivmedizin der Georg August Universität, Robert-Koch-Str. 40, 37075 Göttingen

  • Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim

  • Abteilung für Anästhesie und Intensivtherapie, Klinikum der Philips-Universität, Baldingerstr. 1, 35043 Marburg/Lahn

  • Institut für Anästhesiologie, Klinikum Großhadern, Marchioninistr. 15, 81377 München

  • Universitätsklinik für Anästhesiologie und Intensivmedizin, AKH, Woehringer Gürtel 18–20, 1090 Wien

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Kopp, R., Henzler, D., Dembinski, R. et al. Extrakorporale Membranoxygenierung beim akuten Lungenversagen. Anaesthesist 53, 168–174 (2004). https://doi.org/10.1007/s00101-003-0643-3

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  • DOI: https://doi.org/10.1007/s00101-003-0643-3

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