Invasive Reanimationsverfahren unter Verwendung einer venoarteriellen extrakorporalen Membranoxygenierung (VA-ECMO) haben in den vergangenen Jahren einen deutlichen Aufwind erlebt. Die Ergebnisse erster randomisiert-kontrollierter Studien geben Aufschluss über Vorteile, Nachteile und den hohen Stellenwert der richtigen Indikationsstellung für diese therapeutische Option.
Abstract
In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances in traditional resuscitation measures, out-of-hospital cardiac arrest (OHCA) mortality remains high. In the context of extracorporeal cardiopulmonary resuscitation (ECPR), VA-ECMO therapy offers a promising approach by providing circulatory support during cardiac arrest, allowing time for diagnostic evaluation and targeted therapy. However, patient selection for ECPR remains a challenge, relying on various factors including initial rhythm, duration of no-flow and low-flow states, as well as presence of reversible causes.
Recent studies such as the ARREST, Prague OHCA and INCEPTION trials have investigated the efficacy of ECPR in OHCA patients, yielding mixed results. While the ARREST trial demonstrated a survival benefit with ECPR, the Prague OHCA and INCEPTION trials showed varying outcomes, reflecting the complexity of patient selection and treatment strategies. Despite inherent risks and complications associated with ECPR, it may offer a potential survival advantage under optimal conditions.
Future directions in ECPR involve the development of innovative treatment protocols such as the CARL therapy, which incorporates specialized ECMO systems and tailored perfusion solutions. Early studies indicate promising outcomes with CARL therapy, emphasizing the importance of a well-coordinated and structured approach to ECPR implementation.
In summary, ECPR shows promise in improving survival rates for OHCA patients within a well-organized healthcare system. However, further research is needed to refine patient selection criteria and optimize treatment protocols, ultimately enhancing patient outcomes in cardiac arrest scenarios.
Schlüsselwörter
Reanimation - Wiederbelebung - Herz-Kreislauf-Stillstand - ECPR - ECMO
Keywords
extracorporeal pulmonary resuscitation - ECPR - cardiac arrest - ECMO
