Invasive Reanimationsverfahren unter Verwendung einer venoarteriellen extrakorporalen
Membranoxygenierung (VA-ECMO) haben in den vergangenen Jahren einen deutlichen Aufwind
erlebt. Die Ergebnisse erster randomisiert-kontrollierter Studien geben Aufschluss
über Vorteile, Nachteile und den hohen Stellenwert der richtigen Indikationsstellung
für diese therapeutische Option.
Abstract
In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal
membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances
in traditional resuscitation measures, out-of-hospital cardiac arrest (OHCA) mortality
remains high. In the context of extracorporeal cardiopulmonary resuscitation (ECPR),
VA-ECMO therapy offers a promising approach by providing circulatory support during
cardiac arrest, allowing time for diagnostic evaluation and targeted therapy. However,
patient selection for ECPR remains a challenge, relying on various factors including
initial rhythm, duration of no-flow and low-flow states, as well as presence of reversible
causes.
Recent studies such as the ARREST, Prague OHCA and INCEPTION trials have investigated
the efficacy of ECPR in OHCA patients, yielding mixed results. While the ARREST trial
demonstrated a survival benefit with ECPR, the Prague OHCA and INCEPTION trials showed
varying outcomes, reflecting the complexity of patient selection and treatment strategies.
Despite inherent risks and complications associated with ECPR, it may offer a potential
survival advantage under optimal conditions.
Future directions in ECPR involve the development of innovative treatment protocols
such as the CARL therapy, which incorporates specialized ECMO systems and tailored
perfusion solutions. Early studies indicate promising outcomes with CARL therapy,
emphasizing the importance of a well-coordinated and structured approach to ECPR implementation.
In summary, ECPR shows promise in improving survival rates for OHCA patients within
a well-organized healthcare system. However, further research is needed to refine
patient selection criteria and optimize treatment protocols, ultimately enhancing
patient outcomes in cardiac arrest scenarios.
Schlüsselwörter
Reanimation - Wiederbelebung - Herz-Kreislauf-Stillstand - ECPR - ECMO
Keywords
extracorporeal pulmonary resuscitation - ECPR - cardiac arrest - ECMO
