Extrakorporale Membranoxygenierung in der Thoraxchirurgie – Lungentransplantation

Zusammenfassung

Die extrakorporale Membranoxygenierung (ECMO) hat sich zu einem Standardverfahren in der Thoraxchirurgie entwickelt. Vor allem im Bereich der Lungentransplantation haben aktuelle Entwicklungen zu einer weiten Verbreitung beigetragen. Die ECMO wird zum einen zunehmend zur Überbrückung zur Transplantation angewandt, wobei die besten Ergebnisse in diesem Setting mit wachen Patienten erzielt werden. Zum anderen hat die ECMO die konventionelle Herz-Lungen-Maschine zur intraoperativen Unterstützung während der Lungentransplantation in den meisten Zentren abgelöst und wird weiterhin zur Behandlung und Prävention des primären Graftversagens eingesetzt. Verbesserungen der Technik, der Methode und des Kanülendesigns erlauben mittlerweile eine höchst individualisierte Anwendung, angepasst an die respiratorische und hämodynamische Situation sowie an die zu erwartende Therapiedauer.

Abstract

Extracorporeal membrane oxygenation (ECMO) has become a routine method in thoracic surgery. Recent developments in lung transplantation have led to its widespread acceptance. Firstly, ECMO is increasingly being used to bridge patients to transplantation. The best results in this setting have been described with “awake ECMO”. Secondly, ECMO has replaced cardio-pulmonary bypass as the intraoperative standard device in most centres and is used for treatment and prevention of primary graft dysfunction. Refinements of the devices in use and the cannula design allow an individualised approach tailored to the respiratory and haemodynamic situation of the patients and the anticipated duration of ECMO support.

Schlüsselwörter

ECMO - Lungentransplantation - Überbrückung zur Transplantation - intraoperative extrakorporale Unterstützung

Key words

ECMO - lung transplantation - ECLS - bridge to transplant - intraoperative extracorporeal support

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