Lungenersatzverfahren – Einsatz und Management extrakorporaler Lungenersatzverfahren

Zusammenfassung

Trotz lungenprotektiver Beatmungsstrategien und erweiterter Maßnahmen wie Lagerungstherapie, selektive pulmonale Vasodilatation oder Verfahren zur extrakorporalen CO₂-Elimination (extrakorporale Lungenassistenz) kann der Gasaustausch im schweren akuten Lungenversagen (ARDS) therapierefraktär eingeschränkt bleiben. Um sowohl die Oxygenierung als auch die Ventilation in dieser lebensbedrohlichen Situation zu sichern, müssen extrakorporale Lungenersatzverfahren, auch extrakorporale Membranoxygenierung (ECMO) genannt, eingesetzt werden. Technische Verbesserungen sowie die Miniaturisierung der extrakorporalen Systeme haben sowohl die Sicherheit als auch die Bedienbarkeit revolutioniert. So kann beispielsweise aufgrund der Heparinbeschichtung der Systeme auf eine therapeutische Antikoagulation verzichtet und somit das Risiko von Blutungskomplikationen reduziert werden.

Aktuelle Daten zur ECMO-Therapie deuten daraufhin, dass das Outcome bei Patienten mit schwerem ARDS verbessert werden kann. Diese Übersichtsarbeit beschreibt das Funktionsprinzip sowie das Management der ECMO-Therapie bei Patienten mit ARDS.

Abstract

In patients with the most severe forms of acute respiratory distress syndrome (ARDS) refractory to conventional mechanical ventilation and adjunctive or rescue therapies like kinetic therapy, inhaled vasodilators or extracorporeal CO₂-elimination (extracorporeal lung assist), the use of the extracorporeal membrane oxygenation (ECMO) can secure gas exchange. Due to technical improvements and miniaturization, the new ECMO system is safer and simpler. Nowadays the ECMO-systems are heparin-coated, so that there is no need of therapeutic systemic anticoagulation, and thus bleeding complications are less frequent. Recent data suggests, that outcome of patients with severe ARDS treated with ECMO may improve. This review describes the function and the management of ECMO-therapy in ARDS-patients.

Schlüsselwörter:

Akutes Lungenversagen - ARDS - extrakorporale Membranoxygenierung - ECMO - lungenprotektive Beatmung

Keywords:

Acute Respiratory Distress Syndrome - ARDS - extracorporeal membrane oxygenation - ECMO - lung-protective ventilation

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