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Kardiologie up2date 2017; 13(03): 255-272
DOI: 10.1055/s-0043-117247
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Georg Thieme Verlag KG Stuttgart · New York

Venovenöse extrakorporale Membranoxygenierung

Axel Schmutz
,
Christoph Benk
,
Tobias Wengenmayer
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Publication History

Publication Date:
19 October 2017 (online)

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Das ECMO-Verfahren zur Therapie des akuten Lungenversagens hat sich insbesondere seit der H1N1-Pandemie stark verbreitet. Der routinemäßige Einsatz erfordert jedoch eine sorgfältige Indikationsstellung, eine entsprechende Ausstattung und große Erfahrung.
Kernaussagen

  • Ziel der venovenösen extrakorporalen Membranoxygenierung (VV-ECMO) ist die Versorgung des Körpers mit ausreichend oxygeniertem Blut.

  • Indikationen zur VV-ECMO sind eine schwere Hypoxämie und/oder Hyperkapnie mit hohem Letalitätsrisiko.

  • Es gibt jedoch bislang keine gesicherten Vorteile der VV-ECMO gegenüber der konventionellen Therapie des ARDS.

  • Die VV-ECMO ermöglicht eine protektive Beatmung. Zur Frage der optimalen Beatmungsform gibt es keine Studiendaten.

  • Unter Sedierung ist auch bei ECMO-Patienten eine regelmäßige Beurteilung von Delir, Schmerz und Sedierung obligat. Zur ECMO ist jedoch nicht zwingend eine Sedierung erforderlich.

  • Technische Komplikationen sind selten, können aber gravierend sein. Die bei Weitem häufigste Komplikation unter ECMO ist die Blutung, die bei ca. der Hälfte der Patienten auftritt.

  • Eine ECMO sollten nur Intensivstationen einsetzen, welche die ELSO-Standards zur technischen und personellen Ausstattung erfüllen und über ein entsprechend geschultes Team verfügen.

 

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