Zusammenfassung
Das akute Lungenversagen des Erwachsenen (ARDS) ist nach wie vor mit einer hohen Mortalität
von ca. 40% belastet – eine große Herausforderung für die Intensivmedizin. Dieser
Beitrag erläutert, bei welchen Befundkonstellationen die Lungenersatzverfahren ECMO
(extrakorporale Membranoxygenierung) und ECCO2R (extrakorporale CO2-Elimination) als Rescue-Therapie zum Einsatz kommen können und worauf dabei zu achten
ist.
Abstract
Extracorporeal lung support is increasingly implemented worldwide in clinical practice
in patients with severe acute respiratory distress syndrome (ARDS) and is required
when mechanical ventilation is unable to establish sufficient pulmonary gas exchange
or if the respirator settings are persistent elevated with an increased risk for ventilator
induced lung injury (VILI). Besides that, hypercapnic respiratory failure in patients
with acute exacerbation of COPD (AECOPD) or acute respiratory syndrome (ARDS) is common
and may require extracorporeal elimination of carbon dioxide by ECCO2R, which also has been increasingly used in the clinical setting. For both therapeutic
regimes there is up to date no clear evidence for a significant reduction in mortality
in patients with ARDS. Therefore extracorporeal lung support should be still considered
as a rescue therapy. In this review, based on a selective literature research and
clinical experience of the authors, management of patients with extracorporeal lung
assist, focusing on ECMO and ECCO2R is summarized.
Schlüsselwörter
extrakorporale Lungenersatzverfahren - ECMO - ECCO
2R - Lungenversagen - Dekarboxylierung
Key words
extracorporeal lung support - ECMO - ECCO
2R - lung injury - decarboxylation