Organersatzverfahren - Kreislaufunterstützung und -ersatz

Christopher Lotz; Norbert Roewer; Ralf M Muellenbach

doi:10.1055/s-0041-109831

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51(09): 564-572
DOI: 10.1055/s-0041-109831

Fachwissen: Topthema

Anästhesiologie / Intensivmedizin

Organersatzverfahren - Kreislaufunterstützung und -ersatz

Cardiac support and replacement therapies

Christopher Lotz

¹Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg

,

Norbert Roewer

¹Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg

,

Ralf M Muellenbach

¹Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg

› Author Affiliations

Abstract

Zusammenfassung

Kreislaufunterstützende Maßnahmen sind ein unverzichtbarer Bestandteil in der Versorgung kritisch Kranker. Eine differenzierte pharmakologische Therapie erlaubt die Aufrechterhaltung des systemischen Perfusionsdrucks durch Erhöhung des peripheren Widerstands und positiver Inotropie. Neben der Gabe von Katecholaminen und Phosphodiesterase-3-Inhibitoren zeigt sich insbesondere die Gabe von Levosimendan als vielversprechende Alternative beim Low-Cardiac-Output-Syndrom. Gleichwohl existiert für kein medikamentöses Therapieregime eine ausreichende Evidenz im Hinblick auf ein verbessertes Überleben. Mechanische Herz-Kreislauf-Unterstützung ist bei Versagen medikamentöser Maßnahmen, z.B. während kardiopulmonaler Reanimation, Low-Cardiac-Output-Syndrom, zur kurz- bis mittelfristigen Herz-Kreislauf-Unterstützung indiziert („bridging to decision and recovery“). Die venoarterielle extrakorporale Membranoxygenierung (vaECMO) erlaubt eine komplette Übernahme der kardiopulmonalen Funktion und scheint das Überleben mit gutem neurologischem Outcome bei kardiogenem Schock bzw. kardiopulmonaler Reanimation zu verbessern.

Abstract

Circulatory support represents an integral part within the treatment of the critically ill patient. Sophisticated pharmacologic regimens help to maintain systemic perfusion pressure by increasing vascular tone as well as mediating positive inotropic effects. Besides the administration of catecholamines and phosphodiesterase-III-inhibitors, in particular the administration of levosimendan represents a promising alternative during low-cardiac-output. Nevertheless, sufficient evidence demonstrating a survival benefit for any pharmacologic regimen is nonexistent. In case pharmacological measures do not suffice mechanical cardiopulmonary support (MCS) may be used. MCS may be used during cardiopulmonary resuscitation or a “low-cardiac-output-syndrome” as bridging towards decision, recovery or long-term support. Venoarterial extracorporeal membrane oxygenation (vaECMO) may take over cardiopulmonary function and may improve survival as well as neurological outcome after cardiogenic shock or cardiopulmonary resuscitation.

Schlüsselwörter:

Kreislaufunterstützung - extrakorporale Membranoxygenierung - Katecholamine - Levosimendan - Phosphodiesterase-3-Inhibitoren

Keywords:

cardiac support - extracorporeal membrane oxygenation - catecholamines - levosimendan - phosphodiesterase-III-inhibitors

Full Text

References

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