Der Stellenwert des extrakorporalen Life Supports (ECLS) im refraktären Herz-Kreislauf-Versagen
ist durch eine eigene S3-Leitlinie (2021) und ein erweitertes Indikationsspektrum
in den
europäischen Leitlinien erheblich gestiegen. Mobile ECLS-Teams gewähren zudem einem
zunehmend größeren Behandler- und Patientenkollektiv – auch außerhalb von Zentren
sowie in der Präklinik –
Zugang zu dieser Therapie.
Abstract
Veno-arterial extracorporeal life support (ECLS) may be indicated in patients with
refractory heart failure. The list of conditions in which ECLS is successfully used
is growing and
includes cardiogenic shock following myocardial infarction, refractory cardiac arrest,
septic shock with low cardiac output and severe intoxication. Femoral ECLS is the
most common and often
preferred ECLS-configuration in the emergency setting. Although femoral access is
usually quick and easy to establish, it is also associated with specific adverse haemodynamic
effects due to
the direction of blood flow and access-site complications are inherent. Femoral ECLS
provides adequate oxygen delivery and compensates for impaired cardiac output. However,
retrograde blood
flow into the aorta increases left ventricular afterload and may worsen left ventricular
stroke work. Therefore, femoral ECLS is not equivalent to left ventricular unloading.
Daily
haemodynamic assessments are crucial and should include echocardiography and laboratory
tests determining tissue oxygenation. Common complications include the harlequin-phenomenon,
lower
limb ischaemia or cerebral events and cannula site or intracranial bleeding. Despite
a high incidence of complications and high mortality, ECLS is associated with survival
benefits and
better neurological outcomes in selected patient groups.
Schlüsselwörter
ECLS - femorale Kanülierung - ECLS-Management - Hämodynamik - Überwachung
Keywords
ECLS - femoral access - ECLS-management - haemodynamics - monitoring
