Zusammenfassung
Die extrakorporale kardiopulmonale Reanimation („extracorporeal cardiopulmonary resuscitation“, eCPR) kann als Rettungsversuch für hoch selektierte Patienten mit refraktärem Herz-Kreislauf-Stillstand und potenziell reversibler Ätiologie erwogen werden. Aktuell fehlen randomisiert-kontrollierte Studien zur eCPR und es existieren keine validen Prädiktoren für Nutzen und Risiko, die bei der Indikationsstellung hilfreich sein könnten. Die bisherigen Selektionskriterien und Abläufe sind klinikspezifisch und ein (nationaler) standardisierter Algorithmus fehlt. Das vorliegende Konsensuspapier bietet basierend auf einer konsentierten Expertenmeinung den Vorschlag für ein standardisiertes Vorgehen bei eCPR.
Abstract
Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.
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Interessenkonflikt
G. Michels ist Mitglied des wissenschaftlichen Beirats der Deutschen Gesellschaft für internistische Intensiv- und Notfallmedizin e. V. (DGIIN), kommissarischer Sprecher der Arbeitsgruppe Kardiopulmonale Reanimation der Deutschen Gesellschaft für Kardiologie e. V. (DGK) sowie Mitglied der Arbeitsgruppe ECMO/eCPR des Deutschen Rats für Wiederbelebung e. V./German Resuscitation Council (GRC) und erhielt Honorare für Vortragstätigkeiten von den Firmen Pfizer, Novartis, Servier, Zoll und Orion Pharma. J. Bauersachs ist Sprecher der DFG-geförderten Klinischen Forschergruppe (KFO) 311 „(Prä-) terminale Herz- und Lungeninsuffizienz: Entlastung und Reparatur“ und erhielt Honorare für Vortragstätigkeiten und Forschungsunterstützung von den Firmen Abiomed und Zoll. B. W. Böttiger ist European Resuscitation Council (ERC) Board Director Science and Research, Vorstandsvorsitzender des Deutschen Rats für Wiederbelebung e. V./German Resuscitation Council (GRC), Mitglied in der „Advanced Cardiac Life Support“ (ALS) Task Force des International Liaison Committee on Resuscitation (ILCOR), Mitglied im Präsidium der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Associated Editor des European Journal of Anaesthesiology (EJA), Mitherausgeber der Zeitschrift Resuscitation, Schriftleiter der Zeitschrift Notfall + Rettungsmedizin. Für Vorträge hat er Honorare der folgenden Firmen erhalten: med update GmbH, Forum für Medizinische Fortbildung (FoMF), Baxalta, Bayer Vita, Zoll, BARD. A. Ghanem erhielt Honorare für Vortragstätigkeiten von Getinge. A. Markewitz erhielt ein Vortragshonorar von TÜV Süd, München. J.-T. Gräsner ist 1. Sprecher des Wissenschaftlichen Arbeitskreises Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Sprecher des Organisationskomitees des Deutschen Reanimationsregisters, Chair des European Registry of Cardiac Arrest, Mitglied im Exekutivkomitee des Deutschen Rats für Wiederbelebung, Mitglied im Präsidium des Berufsverbands Deutscher Anästhesisten. U. Kreimeier ist Leiter der Arbeitsgruppe Advanced Life Support im Deutschen Rat für Wiederbelebung e. V./German Resuscitation Council (GRC). T. Wengenmayer, C. Hagl, C. Dohmen, A. Bauer, R. Pfister, H.-J. Busch, A. Beckmann, M. Fischer, C. Kill, U. Janssens, S. Kluge, F. Born, H. M. Hoffmeister, M. Preusch, U. Boeken, R. Riessen und H. Thiele geben an, dass kein Interessenkonflikt besteht.
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Dieses Positionspapier erscheint parallel in den Zeitschriften Medizinische Klinik – Intensivmedizin und Notfallmedizin, Der Kardiologe, Der Anaesthesist, Zeitschrift für Herz‑, Thorax- und Gefäßchirurgie und Anästhesiologie & Intensivmedizin.
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Michels, G., Wengenmayer, T., Hagl, C. et al. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Med Klin Intensivmed Notfmed 113, 478–486 (2018). https://doi.org/10.1007/s00063-018-0452-8
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DOI: https://doi.org/10.1007/s00063-018-0452-8
Schlüsselwörter
- Herz-Kreislauf-Stillstand
- Extrakorporale kardiopulmonale Reanimation
- Extrakorporale Membranoxygenierung
- Kardiogener Schock
- Wiederbelebung