Zusammenfassung
Hintergrund
Der plötzliche Herztod ist häufig und die Prognose selbst bei optimaler Rettungskette schlecht. Die Implantation einer miniaturisierten Herzlungenmaschine unter kardiopulmonaler Reanimation (CPR) wird als extrakorporale CPR (eCPR) bezeichnet. Seit den ab Oktober 2015 gültigen Advanced Life Support Leitlinien kann die eCPR bei ausgesuchten Patienten erwogen werden.
Zielsetzung
Vermittlung der Grundlagen der eCPR sowie Darstellung der Anforderungen an Material, Helfer und die lokalen Strukturen.
Material und Methode
Diskussion der aktuellen Literatur sowie gültiger Leitlinien.
Ergebnisse
Die eCPR kann sowohl nach innerklinischem als auch außerklinischem Herzkreislaufstillstand unter kontrollierten Bedingungen erfolgen. Ein hoher technischer und personeller Aufwand ist jedoch erforderlich. Die Implantation einer Herzlungenmaschine unter CPR dauert ca. 30 min. Eine kleine Studie mit kurzer Latenz zwischen Kollaps und eCPR berichtet ein Überleben in 54 % der Patienten. Studien mit längerer Latenz zeigen weniger positive Ergebnisse.
Schlussfolgerungen
Eine Prognoseverbesserung ausgesuchter Patienten durch die eCPR erscheint plausibel, ist aber noch nicht wissenschaftlich belegt. Ein Nutzen kann möglicherweise nur bei früher eCPR erreicht werden.
Abstract
Background
Sudden cardiac death is frequent, and prognosis of survival—even with an optimal rescue chain—is poor. Implantation of a miniaturized heart–lung machine during cardiopulmonary resuscitation (CPR) is referred to as extracorporeal CPR (eCPR). The current 2015 Advanced Life Support (ALS) guidelines advocate consideration of eCPR in selected patients.
Objectives
Discussion of eCPR basics and requirements for material, staff, and local structures.
Materials and methods
Review of current guidelines and published data.
Results
eCPR, which can be performed within a controlled environment after in-hospital and out-of-hospital cardiac arrest, is associated with high technical and personnel expenses. The implantation of a heart–lung machine during CPR takes about 30 min. A study with early eCPR after sudden cardiac death reported a 54 % patient survival. Studies with greater delay between collapse and eCPR show less favorable results.
Conclusion
An improved survival in selected patients using eCPR seems plausible, however has not been scientifically proven. A benefit in survival might be only achievable with early eCPR.
Abbreviations
- ALS:
-
Advanced Life Support
- CPR:
-
Kardiopulmonale Reanimation
- ECLS:
-
Extrakorporale Life Support
- eCPR:
-
Extrakorporale CPR
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A. Supady, T. Wengenmayer, C. Bode und D. L. Staudacher geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Supady, A., Wengenmayer, T., Bode, C. et al. Extrakorporale CPR (eCPR). Notfall Rettungsmed 19, 574–581 (2016). https://doi.org/10.1007/s10049-016-0166-5
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DOI: https://doi.org/10.1007/s10049-016-0166-5
Schlüsselwörter
- Extrakorporale kardiopulmonale Reanimation
- Extrakorporale Life Support
- Advanced Life Support
- Kardiopulmonale Reanimation
- Herzstillstand