Zehn Jahre Erfahrung mit extra-korporaler Membranoxygenierung (ECMO)[1]

Zusammenfassung.

Hintergrund: Extrakorporale Membranoxygenierung (Extracorporeal Membrane Oxygenation: ECMO) ist eine supportive Behandlung für das schwere Lungenversagen. Wir beschreiben unsere Behandlungsergebnisse bei 245 Patienten mit schwerem ARDS (Acute Respiratory Distress Syndrome), von denen 62 mit der ECMO behandelt wurden. Methodik: Die Daten aller ARDS-Patienten wurden zwischen 1991 und 1999 prospektiv erfasst. Neben der Überlebensrate wurden mehrere klinische Parameter sowohl bei den mit ECMO als auch bei den konventionell behandelten Patienten aufgeführt und evaluiert. Ergebnisse: 138 Patienten wurden uns aus auswärtigen Kliniken zugewiesen, 107 Patienten stammten aus Freiburg, z. T. von anderen hausinternen Intensivstationen. Von den mit ECMO behandelten Patienten überlebten 55 %. ECMO war mit sehr wenigen Komplikationen verbunden (eine davon tödlich). Kein Parameter, der zu Beginn oder während der ECMO-Behandlung erhoben wurde, erlaubte die Vorhersage der individuellen Prognose. Von den konventionell behandelten Patienten, bei denen der pulmonale Gasaustausch weniger stark eingeschränkt war, überlebten 61 %. Schlussfolgerung: ECMO ist eine wichtige Behandlungsoption bei schwerem ARDS. Allerdings wurde eine dadurch erreichbare höhere Überlebensrate bislang in keiner randomisierten kontrollierten Studie nachgewiesen. Bis zur Entwicklung einer kausalen oder in anderer Hinsicht überlegenen Therapie sollte ECMO bei ausgewählten Patienten eingesetzt werden.

Ten Years of Experience in Extracorporeal Membrane Oxygenation.

Objective: Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used for severe acute respiratory distress syndrome (ARDS). We present outcome, clinical parameters, and complications in a cohort of 245 ARDS patients of whom 62 were treated with ECMO. Methods: Data of all ARDS patients were prospectively collected between 1991 and 1999. Outcome and clinical parameters of patients treated with and without ECMO were evaluated. Results: Hundred-thirty-eight patients were referred from other hospitals, 107 were primarily located in our hospital. About one fourth of these patients was treated with ECMO. The survival rate was 55 % in ECMO patients and 61 % in non-ECMO patients. ECMO resulted in very few complications, one of them was fatal. No parameter before or during ECMO could be used to predict the individual prognosis. Conclusion: ECMO is a therapeutic option for patients with severe ARDS, likely to increase survival. However, a randomized controlled study proving its benefit is still awaited. Until the development of a causal or otherwise superior therapy ECMO should be used in selected patients.

Schlüsselwörter:

ECMO - ARDS - ALI

Key words:

ECMO - ARDS - ALI

1 Diese Arbeit ist Herrn Prof. Dr. Klaus Geiger zum 60. Geburtstag gewidmet. Teile dieses Manuskripts wurden publiziert in: The American Journal of Surgery 2000; 180: 144-154. Mols et al.: Extracorporeal Membrane Oxygenation (ECMO) - A Ten-Year Experience.  Abdruck in überarbeiteter Form mit Genehmigung durch Excerpta Medica Inc.

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1 Diese Arbeit ist Herrn Prof. Dr. Klaus Geiger zum 60. Geburtstag gewidmet. Teile dieses Manuskripts wurden publiziert in: The American Journal of Surgery 2000; 180: 144-154. Mols et al.: Extracorporeal Membrane Oxygenation (ECMO) - A Ten-Year Experience.  Abdruck in überarbeiteter Form mit Genehmigung durch Excerpta Medica Inc.