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Erschienen in:

25.01.2017 | CME

Passagere Herzunterstützungssysteme

verfasst von: Dr. D. L. Staudacher, P. M. Biever, D. Dürschmied, T. Wengenmayer, C. Bode, I. Ahrens

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 1/2017

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Zusammenfassung

Als mechanische linksventrikuläre Unterstützungssysteme für Patienten mit konservativ nichtstabilisierbarer Herzinsuffizienz stehen die intraaortale Ballonpumpe (IABP), die Impella™-Pumpe, das TandemHeart™ und die extrakorporale Membranoxygenierung (ECMO) zur Verfügung. Aufgrund ihres Unterschieds in Aufbau und Wirkweise sind die spezifischen Indikationen und der individuelle potenzielle Nutzen für den Patienten zu berücksichtigen. Anhand der Haupteinsatzgebiete kardiogener Schock, prophylaktische Anlage bei kardialen Hochrisikoeingriffen und Reanimation ohne Wiedererlangen eines Spontankreislaufs werden die Systeme im Folgenden beleuchtet. Mechanische linksventrikuläre Unterstützungssysteme sind komplikationsbehaftet; sowohl akute als auch erst nach Explantation auftretende vaskuläre Komplikationen sind zu beachten. Diese sind dem potenziell lebensrettenden Nutzen gegenüberzustellen und können durch Expertise, Weiterentwicklung der Systeme und verbesserte Nachsorge reduziert werden.
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Literatur
1.
Zurück zum Zitat Thiele H et al (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382(9905):1638–1645CrossRefPubMed Thiele H et al (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382(9905):1638–1645CrossRefPubMed
2.
Zurück zum Zitat Shekar K, Gregory SD, Fraser JF (2016) Mechanical circulatory support in the new era: an overview. Crit Care 20(1):1–12CrossRef Shekar K, Gregory SD, Fraser JF (2016) Mechanical circulatory support in the new era: an overview. Crit Care 20(1):1–12CrossRef
4.
Zurück zum Zitat Burkhoff D et al (2006) A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 152(3):469.e1–469.e8CrossRef Burkhoff D et al (2006) A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 152(3):469.e1–469.e8CrossRef
5.
Zurück zum Zitat Stub D et al (2015) Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation 86:88–94CrossRefPubMed Stub D et al (2015) Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation 86:88–94CrossRefPubMed
6.
Zurück zum Zitat Briasoulis A et al (2016) Meta-analysis of usefulness of Percutaneous left ventricular assist devices for high-risk Percutaneous coronary interventions. Am J Cardiol 118(3):369–375CrossRefPubMed Briasoulis A et al (2016) Meta-analysis of usefulness of Percutaneous left ventricular assist devices for high-risk Percutaneous coronary interventions. Am J Cardiol 118(3):369–375CrossRefPubMed
7.
Zurück zum Zitat Staudacher DL et al (2015) Unprotected left main Percutaneous coronary intervention in acute coronary syndromes with Extracorporeal life support backup. Scientifica (Cairo) 2015. doi:10.1155/2015/435878 Staudacher DL et al (2015) Unprotected left main Percutaneous coronary intervention in acute coronary syndromes with Extracorporeal life support backup. Scientifica (Cairo) 2015. doi:10.​1155/​2015/​435878
8.
Zurück zum Zitat Burkhoff D, Naidu SS (2012) The science behind percutaneous hemodynamic support: a review and comparison of support strategies. Catheter Cardiovasc Interv 80(5):816–829CrossRefPubMed Burkhoff D, Naidu SS (2012) The science behind percutaneous hemodynamic support: a review and comparison of support strategies. Catheter Cardiovasc Interv 80(5):816–829CrossRefPubMed
9.
Zurück zum Zitat Werdan K et al (2011) Deutsch-österreichische S3-Leitlinie Infarktbedingter kardiogener Schock. Diagnose, Monitoring und Therapie. Kardiologe 5(3):166–224CrossRef Werdan K et al (2011) Deutsch-österreichische S3-Leitlinie Infarktbedingter kardiogener Schock. Diagnose, Monitoring und Therapie. Kardiologe 5(3):166–224CrossRef
10.
11.
Zurück zum Zitat Thiele H et al (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. New Engl J Med 367(14):1287–1296CrossRefPubMed Thiele H et al (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. New Engl J Med 367(14):1287–1296CrossRefPubMed
12.
13.
Zurück zum Zitat O’Neill WW et al (2014) The current use of Impella 2.5 in acute myocardial infarction complicated by Cardiogenic shock: results from the USpella registry. J Interv Cardiol 27(1):1–11CrossRefPubMed O’Neill WW et al (2014) The current use of Impella 2.5 in acute myocardial infarction complicated by Cardiogenic shock: results from the USpella registry. J Interv Cardiol 27(1):1–11CrossRefPubMed
14.
Zurück zum Zitat Kawashima D et al (2011) Left ventricular mechanical support with Impella provides more ventricular unloading in heart failure than extracorporeal membrane oxygenation. Asaio J 57(3):169–176CrossRefPubMed Kawashima D et al (2011) Left ventricular mechanical support with Impella provides more ventricular unloading in heart failure than extracorporeal membrane oxygenation. Asaio J 57(3):169–176CrossRefPubMed
16.
Zurück zum Zitat Vranckx P et al (2008) The TandemHeart, percutaneous transseptal left ventricular assist device: a safeguard in high-risk percutaneous coronary interventions. The six-year Rotterdam experience. EuroIntervention 4(3):331–337CrossRefPubMed Vranckx P et al (2008) The TandemHeart, percutaneous transseptal left ventricular assist device: a safeguard in high-risk percutaneous coronary interventions. The six-year Rotterdam experience. EuroIntervention 4(3):331–337CrossRefPubMed
18.
Zurück zum Zitat Hochman JS et al (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. New Engl J Med 341(9):625–634CrossRefPubMed Hochman JS et al (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. New Engl J Med 341(9):625–634CrossRefPubMed
19.
Zurück zum Zitat Sheu J‑J et al (2010) Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med 38(9):1810–1817CrossRefPubMed Sheu J‑J et al (2010) Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med 38(9):1810–1817CrossRefPubMed
20.
Zurück zum Zitat Ouweneel DM et al (2016) Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 42(12):1922–1934CrossRefPubMedPubMedCentral Ouweneel DM et al (2016) Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 42(12):1922–1934CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Cheng JM et al (2009) Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. doi:10.1093/eurheartj/ehp292 Cheng JM et al (2009) Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. doi:10.​1093/​eurheartj/​ehp292
22.
23.
Zurück zum Zitat Pappalardo F et al (2016) Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail. doi:10.1002/ejhf.668 PubMed Pappalardo F et al (2016) Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail. doi:10.​1002/​ejhf.​668 PubMed
24.
Zurück zum Zitat Reynolds JC et al (2013) Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation 128(23):2488–2494CrossRefPubMedPubMedCentral Reynolds JC et al (2013) Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation 128(23):2488–2494CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Ditchey RV, Winkler JV, Rhodes CA (1982) Relative lack of coronary blood flow during closed-chest resuscitation in dogs. Circulation 66(2):297–302CrossRefPubMed Ditchey RV, Winkler JV, Rhodes CA (1982) Relative lack of coronary blood flow during closed-chest resuscitation in dogs. Circulation 66(2):297–302CrossRefPubMed
26.
Zurück zum Zitat Hatlestad D (2004) Capnography as a predictor of the return of spontaneous circulation. Emerg Med Serv 33(8):75–80 (quiz 115)PubMed Hatlestad D (2004) Capnography as a predictor of the return of spontaneous circulation. Emerg Med Serv 33(8):75–80 (quiz 115)PubMed
27.
Zurück zum Zitat Kim SJ et al (2016) Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis. Resuscitation 103:106–116CrossRefPubMed Kim SJ et al (2016) Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis. Resuscitation 103:106–116CrossRefPubMed
28.
Zurück zum Zitat Brennan JM et al (2013) Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 6(8):790–799CrossRefPubMed Brennan JM et al (2013) Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 6(8):790–799CrossRefPubMed
30.
Zurück zum Zitat Mishra S et al (2006) Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 98(5):608–612CrossRefPubMed Mishra S et al (2006) Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 98(5):608–612CrossRefPubMed
31.
Zurück zum Zitat O’Neill WW et al (2012) A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 126(14):1717–1727CrossRefPubMed O’Neill WW et al (2012) A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 126(14):1717–1727CrossRefPubMed
32.
Zurück zum Zitat Kovacic JC et al (2015) Patients with 3‑vessel coronary artery disease and impaired ventricular function undergoing PCI with Impella 2.5 hemodynamic support have improved 90-day outcomes compared to intra-aortic balloon pump: a sub-study of the PROTECT II trial. J Interv Cardiol 28(1):32–40CrossRefPubMed Kovacic JC et al (2015) Patients with 3‑vessel coronary artery disease and impaired ventricular function undergoing PCI with Impella 2.5 hemodynamic support have improved 90-day outcomes compared to intra-aortic balloon pump: a sub-study of the PROTECT II trial. J Interv Cardiol 28(1):32–40CrossRefPubMed
33.
Zurück zum Zitat Vranckx P et al (2003) Clinical introduction of the Tandemheart, a percutaneous left ventricular assist device, for circulatory support during high-risk percutaneous coronary intervention. Int J Cardiovasc Intervent 5(1):35–39CrossRefPubMed Vranckx P et al (2003) Clinical introduction of the Tandemheart, a percutaneous left ventricular assist device, for circulatory support during high-risk percutaneous coronary intervention. Int J Cardiovasc Intervent 5(1):35–39CrossRefPubMed
34.
Zurück zum Zitat Cheng R et al (2014) Complications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients. Ann Thorac Surg 97(2):610–616CrossRefPubMed Cheng R et al (2014) Complications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients. Ann Thorac Surg 97(2):610–616CrossRefPubMed
Metadaten
Titel
Passagere Herzunterstützungssysteme
verfasst von
Dr. D. L. Staudacher
P. M. Biever
D. Dürschmied
T. Wengenmayer
C. Bode
I. Ahrens
Publikationsdatum
25.01.2017
Verlag
Springer Medizin
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 1/2017
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-016-0264-4

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