Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(1): 26-33
DOI: 10.1055/s-0040-100249
Fachwissen
Notfallmedizin
© Georg Thieme Verlag Stuttgart · New York

Patienten mit linksventrikulären Assist Devices – Typische Notfälle versorgen

Mechanically circulatory support devices – Management of typical emergencies
Felix F Girrbach
,
Udo X Kaisers
,
Anna L Meyer
Further Information

Publication History

Publication Date:
29 January 2015 (online)

Zusammenfassung

Die Implantation mechanischer Herzunterstützungssysteme konnte das Überleben und die Lebensqualität von Patienten mit terminaler Herzinsuffizienz deutlich verbessern und wird in den kommenden Jahren zunehmend an Bedeutung gewinnen. Notfallmediziner werden daher häufiger mit Patienten konfrontiert werden, bei denen ein ventrikuläres Assist Device (VAD) implantiert wurde.

Die Notfallversorgung von VAD-Patienten ist bisher jedoch nicht standardisiert. Der folgende Artikel gibt einen Überblick der beiden wichtigsten, aktuell gebräuchlichen Systeme, diskutiert typische VAD-assoziierte Notfälle und gibt Handlungsempfehlungen für das Notfallteam. Dazu wird ein von den Autoren vorgeschlagener Algorithmus zur strukturierten und zügigen Evaluation des VAD-Patienten vorgestellt und Besonderheiten in der Notfallversorgung dieser Patientengruppe diskutiert.

Abstract

The use of mechanically circulatory support devices (MCS) will become increasingly important as a therapy option in patients with end-stage heart failure, and emergency physicians will more frequently encounter MCS patients in the next few years.

However, emergency management in MCS patients has not yet been standardized. In the following article, common MCS devices are presented and typical emergencies associated with MCS devices are discussed. Furthermore, we try to give recommendations for the management of MCS patients in an emergency situation and present an algorithm in order to facilitate a structured and timely efficient evaluation of the MCS patient.

Kernaussagen

  • Typische Notfallbilder bei LVAD-Patienten (LVAD = linksventrikuläres Assist Device) sind niedriger Systemfluss, Blutungskomplikationen, Rechtsherzversagen, Hypotonie, Arrhythmien und neurologische Komplikationen.

  • Pulsoxymetrie und nicht invasive Blutdruckmessung sind bei LVAD-Patienten nicht immer zuverlässig möglich und müssen ggf. durch eine klinische Beurteilung des Patienten ersetzt werden.

  • LVAD-Systeme sind vorlastabhängig und nachlastsensibel.

  • Der Ausfall eines LVAD-Systems erfordert eine zügige Evaluation des Patienten, eine Überprüfung aller Steckverbindungen und eine schnelle Kontaktaufnahme mit dem zuständigen LVAD-Zentrum.

Ergänzendes Material

 
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