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Extrakorporale Membranoxygenierung

Prinzip und internistische Indikationen

Extracorporeal membrane oxygenation

Principles and medical indications

  • Schwerpunkt: Interventionelle Therapien II
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Bei der extrakorporalen Membranoxygenierung (ECMO) handelt es sich um eine Art miniaturisierte Herz-Lungen-Maschine zur Stabilisierung schwerst kranker Patienten. Je nach Kanülierungstechnik kann das System zur extrakorporalen Unterstützung bzw. als Ersatz der Herz- und/oder Lungenfunktion eingesetzt werden. Nicht nur aufgrund der zeitlichen Limitierung des Verfahrens müssen Indikationen sowie Kontraindikationen sorgfältig geprüft werden. Prinzipiell unterscheidet man folgende Konzepte der ECMO nach dem jeweiligen Therapieziel: Überbrückung bis zur Wiederherstellung der Organfunktion; Überbrückung bis zur Evaluation des weiteren Vorgehens; Überbrückung bis zur Transplantation oder Implantation eines permanenten Organersatzes, z. B. eines ventrikulären Unterstützungssystems. Aufgrund der Invasivität, der potenziellen Komplikationen sowie der notwendigen standardisierten Überwachung und kardiotechnischen Infrastruktur sollten diese Verfahren sog. High-volume-Zentren vorbehalten bleiben.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a special form of a miniaturized heart–lung machine with the ultimate goal to stabilize critically ill patients. Dependent on the cannulation strategy ECMO can support or replace heart and/or lung function. Medical indications and contraindications have to be evaluated thoroughly before cannulation. Moreover, before ECMO initiation a solid treatment aim has to be defined: bridge to recovery, bridge to decision, bridge to transplantation, and bridge to destination (i. e. implantation of a permanent assist device). Regarding invasiveness of the system, potential life-threatening complications, requirement of standardized monitoring of the patient and the device as well as tertiary care infrastructure, ECMO should exclusively be used in highly experienced tertiary centers.

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Authors and Affiliations

  1. Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    S. David

  2. Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    L. C. Napp

  3. Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    C. Kühn

  4. Klinik für Pneumologie und Deutsches Zentrum für Lungenforschung (DZL), Medizinische Hochschule Hannover, Hannover, Deutschland

    M. M. Hoeper

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  1. S. David
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  4. M. M. Hoeper
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Correspondence to S. David.

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Interessenkonflikt

S. David, L.C. Napp, C. Kühn und M.M. Hoeper geben an, dass kein Interessenkonflikt besteht.

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

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Redaktion

H. Haller, Hannover

G. Hasenfuß, Göttingen

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David, S., Napp, L.C., Kühn, C. et al. Extrakorporale Membranoxygenierung. Internist 57, 856–863 (2016). https://doi.org/10.1007/s00108-016-0102-2

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