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Extrakorporale Membranoxygenierung bei Kindern

Extracorporeal membrane oxygenation in children

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Zusammenfassung

Hintergrund

Kinder, die künstlich beatmet werden müssen, stellen eine Risikogruppe mit hoher Morbidität und Mortalität dar. Eine schonende konventionelle Beatmung, die Hochfrequenzoszillationsventilation und neuere Behandlungsverfahren wie die Therapie mit Surfactant oder Stickstoffmonoxid haben einige Verbesserungen erbracht. Dennoch ist die extrakorporale Membranoxygenierung (ECMO) eine lebensrettende Technik für diejenigen Patienten mit Lungenversagen, bei denen die maximale klinische Therapie nicht greift.

Fragestellung

Dieser Beitrag zeigt das therapeutische Management und die Auswahlkriterien für die ECMO bei Neugeborenen und Kindern ausgehend von den klinischen Zeichen der erworbenen und angeborenen Krankheiten, die zu einem Lungenversagen führen können.

Ergebnisse

Die Diagnoseverteilung und die Überlebensraten sowie der demografische Wandel der ECMO beim Neugeborenen seit dem Beginn der Dokumentation werden aufgezeigt. Im Register der Extracorporeal Life Support Organization (ELSO) wird die Anwendung seit 1986 dokumentiert, die Aufzeichnungen des größten deutschen ECMO-Zentrums in Mannheim reichen bis 1987 zurück. Trotz geänderter Diagnoseverteilung in Richtung angeborener Lungenerkrankungen ist die Überlebensrate bei der ECMO des Neugeborenen deutlich über 70 % geblieben. Auch bei der pädiatrischen ECMO halten sich die Überlebensraten trotz eines komplexeren Patientenguts konstant, wobei die Erfolge bei den jüngsten Patienten ohne Grunderkrankung am höchsten sind.

Schlussfolgerung

Obwohl die Evidenz limitiert ist und nur wenige randomisierte Studien zu Kindern vorliegen, bleibt die ECMO das Sicherheitsnetz für Patienten mit schwerem Lungenversagen. Die Erfahrung gemessen an den jährlichen Fallzahlen spielt für die Ergebnisqualität eine wichtige Rolle.

Abstract

Background

Children who require mechanical ventilation represent a high-risk population with significant morbidity and mortality. Experienced handling of conventional therapies including high frequency oscillation ventilation and initiation of newer treatment options such as surfactant or nitric oxide has led to some improvements. Nevertheless, extracorporeal membrane oxygenation (ECMO) is a life-saving technology in patients with respiratory failure refractory to maximal medical therapy.

Objective

This article shows the therapeutic management and the selection criteria for ECMO in neonates and children based on the clinical signs of acquired and congenital diseases that can lead to respiratory failure.

Results

The distribution of diagnoses, survival rates, and demographic change of ECMO in newborns since the beginning of documentation in 1986 by the Extracorporeal Life Support Organization (ELSO) registry and the largest German ECMO Center Mannheim are described. Despite a changed diagnostic distribution in the direction of congenital pulmonary disease, the survival rate of ECMO in the neonates has remained well above 70 %. In pediatric ECMO, the survival rate has also remained constant despite a more complex patient population. The highest values are seen in the youngest patients without underlying disease.

Conclusion

Despite limited evidence and relatively few randomized trials in children, ECMO remains the safety net for patients with severe respiratory failure. Experience as measured by the annual number of cases plays an important role for the quality of results.

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Correspondence to T. Schaible.

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A. Geppert, Wien

G. Heinz, Wien

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Schaible, T. Extrakorporale Membranoxygenierung bei Kindern. Med Klin Intensivmed Notfmed 110, 438–444 (2015). https://doi.org/10.1007/s00063-015-0062-7

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