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Kardiologie up2date 2022; 18(04): 357-373
DOI: 10.1055/a-1727-1231
Kardiovaskuläre Notfall- und Intensivmedizin

Extrakorporale Membranoxygenierung bei COVID-19

Dominik Wiedemann
,
Thomas Staudinger
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COVID-19-Patienten, die nicht durch mechanische Beatmung und maximale medikamentöse Therapie stabilisiert werden können, kommen für eine ECMO infrage. An der Medizinischen Universität Wien haben wir am Beginn der Pandemie (März 2020) Leitlinien für die Behandlung solcher kritischen Patienten erstellt. Dieser Artikel stellt ein Follow-up zu diesen Leitlinien dar und soll insbesondere auf die bisherigen „lessons learned“ eingehen.
Kernaussagen

  • Die Pandemie hat ECMO-Zentren weltweit vor bislang unbekannte Herausforderungen gestellt und zu einem sprunghaften Zuwachs an Erfahrung und Evidenz geführt.

  • Fragen der Ressourcenallokation je nach verfügbarer Kapazität und eine strikte Balance zwischen Indikationen/Kontraindikationen haben sich als Voraussetzung für eine erfolgreiche Behandlung der schwerstkranken Patienten herausgestellt.

  • Die aufwendige Versorgung von ECMO-Patienten unter Pandemiebedingungen (Personal protective Equipment!) ist Schwerstarbeit und hat sich dennoch mit der Zeit zu einer professionellen Routine entwickelt.

  • Sowohl Patienten mit schwersten Lungenversagen als auch solche mit kardialem Pumpversagen aufgrund von COVID-19 benötigen meist einen hohen Level an ECMO-Support.

  • Von langen ECMO-Laufzeiten muss ausgegangen werden.

  • Das prinzipielle Management der extrakorporalen Therapie sollte nach Standardprotokollen und -kriterien erfolgen.

  • Bei entsprechender Patientenauswahl kann an erfahrenen Zentren mit einer durchaus guten Prognose gerechnet werden.

Schlüsselwörter

Covid-19 - ECMO - veno-venös - veno-arteriell - Patientenmanagement - Intensivstation


Publication History

Article published online:
06 December 2022

© 2022. Thieme. All rights reserved.

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