Skip to main content
Log in

Extrakorporale Verfahren zur Lungenunterstützung

Extracorporeal lung support

  • Leitthema
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Verfahren zur extrakorporalen Lungenunterstützung haben in den letzten Jahren eine rapide technologische Weiterentwicklung mit Verbesserung von Effektivität und Sicherheit erfahren. Trotz der derzeit noch sehr begrenzten wissenschaftlichen Evidenz kommen diese Systeme in der Intensivmedizin zunehmend zur Therapie unterschiedlicher Arten akuter respiratorischer Insuffizienzen zum Einsatz. Die Systeme lassen sich in Verfahren zur extrakorporalen Kohlendioxid (CO2-)Eliminierung (ECCO2R) bei ventilatorischer Insuffizienz und Verfahren zur extrakorporalen Membranoxygenierung (ECMO) bei schwerer hypoxämischer Insuffizienz unterteilen. Trotz der technologischen Fortentwicklung bleiben extrakorporale Lungenunterstützungsverfahren invasive und potenziell komplikationsträchtige Therapieformen mit Blutungen und Gefäßverletzungen als die beiden Hauptkomplikationen. Daher sollten Indikation und Kontraindikationen stets kritisch abgewogen werden und ihr Einsatz nur in Zentren mit entsprechender Erfahrung und Expertise erfolgen.

Abstract

Systems for extracorporeal lung support have recently undergone significant technological improvements leading to more effective and safe treatment. Despite limited scientific evidence these systems are increasingly used in the intensive care unit for treatment of different types of acute respiratory failure. In general two types of systems can be differentiated: devices for extracorporeal carbon dioxide removal (ECCO2R) for ventilatory insufficiency and devices for extracorporeal membrane oxygenation (ECMO) for severe hypoxemic failure. Despite of all technological developments extracorporeal lung support remains an invasive and a potentially dangerous form of treatment with bleeding and vascular injury being the two main complications. For this reason indications and contraindications should always be critically considered and extracorporeal lung support should only be carried out in centers with appropriate experience and expertise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Abrams DC, Brenner K, Burkart KM et al (2013) Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc 10(4):307–314

    Article  CAS  PubMed  Google Scholar 

  2. Abrams D, Javidfar J, Farrand E et al (2014) Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care 18:R38

    Article  PubMed  PubMed Central  Google Scholar 

  3. Abrams DC, Prager K, Blinderman CD (2014) Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults. Chest 145:876–882

    Article  PubMed  Google Scholar 

  4. Allardet-Servent J, Castanier M, Signouret T et al (2015) Safety and efficacy of combined extracorporeal CO2 removal and renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: the pulmonary and renal support in acute respiratory distress syndrome study. Crit Care Med 43:2570–2581

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Banfi C, Pozzi M, Siegenthaler N et al (2016) Veno-venous extracorporeal membrane oxygenation: cannulation techniques. J Thorac Dis 8(12):3762–3773

    Article  PubMed  PubMed Central  Google Scholar 

  6. Barbaro RP, Odetola FO, Kidwell KM et al (2015) Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med 191:894–901

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bein T, Weber-Carstens S, Goldmann A (2013) Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus „conventional“ protective ventilation (6 ml/kg) in severe ARDS. The prospective randomized Xtravent-study. Intensive Care Med 39:847–856

    Article  PubMed  PubMed Central  Google Scholar 

  8. Biscotti M, Gannon WD, Agerstrand C (2017) Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg. doi:10.1016/j.athoracsur.2016.11.056

    PubMed  Google Scholar 

  9. Braune S, Kienast S, Hadem J et al (2013) Safety of percutaneous dilatational tracheostomy in patients onextracorporeal lung support. Intensive Care Med. doi:10.1007/s00134-013-3023-8

    PubMed  Google Scholar 

  10. Braune S, Kluge S (2013) Extracorporeal lung support in patients with chronic obstructive pulmonary disease. Minerva Anestesiol 79:934–943

    CAS  PubMed  Google Scholar 

  11. Braune S, Sieweke A, Brettner F et al (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 42:1437–1444

    Article  CAS  PubMed  Google Scholar 

  12. Brenner K, Abrams DC, Agerstrand CL et al (2014) Extracorporeal carbon dioxide removal for refractory status asthmaticus: experience in distinct exacerbation phenotypes. Perfusion 29(1):26–28

    Article  CAS  PubMed  Google Scholar 

  13. Brochard L, Martin GS, Blanch L et al (2012) Clinical review: respiratory monitoring in the ICU – a consensus of 16. Crit Care 16:219

    Article  PubMed  PubMed Central  Google Scholar 

  14. Burki NK, Mani RK, Herth FJF et al (2013) A novel extracorporeal CO2 removal system. Results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest 143(3):678–686

    Article  CAS  PubMed  Google Scholar 

  15. Combes A, Brodie D, Bartlett R (2014) Position paper for the organization of extracorporeal membrane oxygenation programs for akute respiratory failure in adult patients. Am J Respir Crit Care Med 190(5):488–496

    Article  PubMed  Google Scholar 

  16. Cove ME, MacLaren G, Federspiel WJ et al (2012) Bench to bedside review: extracorporeal carbon dioxide removal, past present and future. Crit Care 16:232

    Article  PubMed  PubMed Central  Google Scholar 

  17. Davies A, Jones D, Beca J et al (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA 302(17):1888–1895

    Article  CAS  PubMed  Google Scholar 

  18. Del Sorbo L, Boffini M, Rinaldi M (2012) Bridging to lung transplantation by extracorporeal support. Minerva Anestesiol 78(2):243–250

    PubMed  Google Scholar 

  19. Del Sorbo L, Fan E, Nava S et al (2016) ECCO2R in COPD exacerbation only for the right patients and with the right strategy. Intensive Care Med 42:1830–1833

    Article  PubMed  Google Scholar 

  20. Del Sorbo L, Pisani L, Filippini C (2015) Extracorporeal CO2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Crit Care Med 43:120–127

    Article  PubMed  Google Scholar 

  21. Enger TB, Philipp A, Videm V et al (2014) Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study. Crit Care 18(2):R27

    Article  Google Scholar 

  22. Extracorporeal Life Support Organization. https://www.elso.org/. Zugegriffen: 26. April 2017

  23. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome (EOLIA). https://clinicaltrials.gov/ct2/show/NCT01470703. Zugegriffen: 26. April 2017

  24. Fan E, Gattinoni L, Combes A et al (2016) Venonenous extracorporeal membrane oxygenation for acute respiratory failure. A clinical review from an international group of experts. Intensive Care Med 42:712–724

    Article  CAS  PubMed  Google Scholar 

  25. Fitzgerald M, Millar J, Blackwood B et al (2014) Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review. Crit Care 18(3):222

    Article  PubMed  PubMed Central  Google Scholar 

  26. Forster C, Schriewer J, John S et al (2013) Low-flow CO2 removal integrated into a renal replacement circuit can reduce acidosis and decrease vasopressor requirements. Crit Care 17(4):R154

    Article  PubMed  PubMed Central  Google Scholar 

  27. Fuehner T, Kuehn C, Hadem J et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185(7):763–768

    Article  PubMed  Google Scholar 

  28. Gattinoni L, Tonetti T, Quintel M (2017) How best to set the ventilator on extracorporeal membrane lung oxygenation. Curr Opin Crit Care 23:66–72

    Article  PubMed  Google Scholar 

  29. Gattinoni L, Marini JJ, Pesenti A et al (2016) The „baby lung“ became an adult. Intensive Care Med 42(5):663–673

    Article  PubMed  Google Scholar 

  30. Gottschalk A, Bräuning J, Brause D (2016) Early goal directed physiotherapy in patients undergoing extracorporeal cardiac life support. Int J Sci Eng Res 7(1):1589–1600

    Google Scholar 

  31. Graf T, Thiele H (2017) Kardiale Unterstützungs- und Ersatzsysteme. Med Klin Intensivmed Notfmed. doi:10.1007/s00063-017-0295-8

  32. Gray BW, Haft JW, Hirsch JC et al (2015) Extracorporeal life support: experience with 2000 patients. ASAIO J 61:2–7

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hoeper MM, Wiesner O, Hadem J (2013) Extracorporeal membrane oxygenation instead of invasive mechanical ventilation in patients with acute respiratory distress syndrome. Intensive Care Med 39(11):2056–2057

    Article  PubMed  Google Scholar 

  34. Kalbhenn J, Wittau N, Schmutz A et al (2015) Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion 30(8):675–682

    Article  CAS  PubMed  Google Scholar 

  35. Kalbhenn J, Neuffer N, Zieger B (2017) Is extracorporeal CO2-removal „safe“ and „less“ invasive? Observation of blood injury and coagulation impairment during ECCO2R. ASAIO J. doi:10.1097/MAT.0000000000000544

    PubMed  Google Scholar 

  36. Karagiannidis C, Auf’m Kampe K, Sipmann FS (2014) Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis. Pathphysiologic and technical considerations. Crit Care 18(3):R124

    Article  PubMed  PubMed Central  Google Scholar 

  37. Karagiannidis C, Brodie D, Strassmann S et al (2016) Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. doi:10.1007/s00134-016-4273-z

    PubMed  Google Scholar 

  38. Kluge S, Braune S, Engel M (2012) Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 38:1632–1639

    Article  PubMed  Google Scholar 

  39. Kluge S, Sensen B, Braune S (2017) Extrakorporale Lungenunterstützung bei Patienten mit ARDS. Dtsch Med Wochenschr 142:88–95

    Article  PubMed  Google Scholar 

  40. Kolobow T, Gattinoni L, Tomlinson TA et al (1977) Control of breathing using an extracorporeal membrane lung. Anesthesiology 46(2):138–141

    Article  CAS  PubMed  Google Scholar 

  41. Kumar A, Zarynchanski R, Pinto R et al (2009) Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA 302(17):1872–1879

    Article  CAS  PubMed  Google Scholar 

  42. Langer T, Santini A, Bottino N (2016) „Awake“ extracorporeal membrane oxygenation (ECMO): pathphysiology, technical considerations, and clinical peoneering. Crit Care 20:150

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lund LW, Federspiel WJ (2013) Removing extra CO2 in COPD patients. Curr Respir Care Rep 2:131–138

    Article  PubMed  PubMed Central  Google Scholar 

  44. Luyt CE, Bréchot N, Demondion P et al (2016) Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 42(5):897–907

    Article  CAS  PubMed  Google Scholar 

  45. Morelli A, Del Sorbo L, Pesenti A et al (2017) Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure. Intensive Care Med. doi:10.1007/s00134-016-4673-0

    Google Scholar 

  46. Muellenbach R, Kredel M, Kunze E et al (2012) Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma 72(5):1444–1447

    Google Scholar 

  47. Müller T, Bein T, Philipp A et al (2013) Extracorporeal pulmonary support in severe pulmonary failure in adult. Dtsch Arztebl Int 110(10):159–166

    PubMed  PubMed Central  Google Scholar 

  48. Napp LC, Kühn C, Bauersachs J (2017) ECMO in cardiac arrest and cardiogenic shock. Herz 42:27–44

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Nierhaus A, Frings DP, Braune S et al (2011) Interventional lung assist enables lung protective mechanical ventilation in acute respiratory distress syndrome. Minerva Anestesiol 77:797–801

    CAS  PubMed  Google Scholar 

  50. Peek GJ, Mugford M, Tiruvoipati R et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR), a multicentre randomised controlled trial. Lancet 374:1351–1363

    Article  PubMed  Google Scholar 

  51. Pesenti A, Patroniti N, Fumagalli R (2010) Carbon dioxide dialysis will save the lung. Crit Care Med 38:549–554

    Article  Google Scholar 

  52. Petzoldt M, Braune S, Bittmann I et al (2012) Rescue therapy with a pumpless extracorporeal lung assist device in a patient with acute interstitial lung disease and severe refractory hypercapnia. Respir Care 57(2):293–297

    PubMed  Google Scholar 

  53. Rozencwajg S, Pilcher D, Combes A et al (2016) Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with ECMO. Crit Care 20:392

    Article  PubMed  PubMed Central  Google Scholar 

  54. Schmidt M, Pilcher D (2014) Mortality prediction models in ARF treated with extracorporeal membrane oxygenation: it must be firstly designed for clinicians and bedside use. Crit Care 18(4):445

    Article  PubMed  PubMed Central  Google Scholar 

  55. Schmidt M, Tachon G, Devillier C et al (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838–846

    Article  CAS  PubMed  Google Scholar 

  56. Schmidt M, Zogheib E, Rozè H et al (2013) The PRESERVE mortality risc score and analysis of long term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39(10):1704–1713

    Article  CAS  PubMed  Google Scholar 

  57. Serpa Neto A, Schmidt M, Azevedo LC et al (2016) Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis: mechanical ventilation during ECMO. Intensive Care Med 42:1672–1684

    Article  CAS  PubMed  Google Scholar 

  58. Sklar MC, Beloncle F, Katsios CM (2015) Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review. Intensive Care Med. doi:10.1007/s00134-015-3921-z

    PubMed  Google Scholar 

  59. Staudinger T (2016) Extracorporeal lung support – news and future developements? Med Klin Intensivmed Notfmed. doi:10.1007/s00063-016-0182-8

    PubMed  Google Scholar 

  60. Strategy of ultraprotective lung ventilation with extracorporeal CO2 removal for new-onset moderate to severe ARDS (SUPERNOVA). https://clinicaltrials.gov/ct2/show/NCT02282657. Zugegriffen: 26. April 2017

  61. Thiagarajan RR, Barbaros RP, Rycus PT (2017) ELSO Registry international report 2016. ASAIO J 63:60–67

    Article  PubMed  Google Scholar 

  62. Trudzinski FC, Minko P, Rapp D (2016) Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis. Ann Intensive Care 6:66

    Article  PubMed  PubMed Central  Google Scholar 

  63. Welterer S, Schmidt K, Deininger M (2016) Komplexe Fokussanierung in der Sepsis. Extrakorporale Membranoxygenierung (ECMO) als Bridging-Konzept zur trachealen Fistelsanierung bei sepsisassoziiertem ARDS. Anaesthesist 65:696–702

    Article  Google Scholar 

  64. Westermaier T, Stetter C, Kunze E et al (2016) Controlled hypercapnia enhances cerebral blood flow and brain tissue oxygenation after aneurysmal subarachnoid hemmorrhage: results of a phase I study. Neurocrit Care 25:205–214

    Article  CAS  PubMed  Google Scholar 

  65. Westhoff M, Bachmann M, Braune S et al (2016) Schweres hyperkapnisches Atemversagen bei akuter COPD-Exazerbation: Stellenwert von Beatmung und ECCO2R. Dtsch Med Wochenschr 141:1758–1717

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Kluge.

Ethics declarations

Interessenkonflikt

S. Braune hat Vortragshonorare von der Novalung GmbH erhalten. S. Kluge ist Mitglied im Advisory Board der Novalung GmbH und der Firma Gambro, er hat zudem Vortragshonorare von der Novalung GmbH und der Firma Gambro erhalten. A. Sieweke und D. Jarczak geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

S. Kluge, Hamburg

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Braune, S., Sieweke, A., Jarczak, D. et al. Extrakorporale Verfahren zur Lungenunterstützung. Med Klin Intensivmed Notfmed 112, 426–436 (2017). https://doi.org/10.1007/s00063-017-0304-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-017-0304-y

Schlüsselwörter

Keywords

Navigation