Organersatzverfahren: Update Lungenersatzverfahren

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 - ECCO₂R - Lungenversagen - Dekarboxylierung

Key words

extracorporeal lung support - ECMO - ECCO₂R - lung injury - decarboxylation

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