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DOI: 10.1055/a-2082-8761
Extrakorporale kardiopulmonale Reanimation (ECPR) – die Zukunft?
Extracorporeal Cardiopulmonary Resuscitation(ECPR) - the Future?
Invasive Reanimationsverfahren unter Verwendung einer venoarteriellen extrakorporalen Membranoxygenierung (VA-ECMO) haben in den vergangenen Jahren einen deutlichen Aufwind erlebt. Die Ergebnisse erster randomisiert-kontrollierter Studien geben Aufschluss über Vorteile, Nachteile und den hohen Stellenwert der richtigen Indikationsstellung für diese therapeutische Option.
Abstract
In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances in traditional resuscitation measures, out-of-hospital cardiac arrest (OHCA) mortality remains high. In the context of extracorporeal cardiopulmonary resuscitation (ECPR), VA-ECMO therapy offers a promising approach by providing circulatory support during cardiac arrest, allowing time for diagnostic evaluation and targeted therapy. However, patient selection for ECPR remains a challenge, relying on various factors including initial rhythm, duration of no-flow and low-flow states, as well as presence of reversible causes.
Recent studies such as the ARREST, Prague OHCA and INCEPTION trials have investigated the efficacy of ECPR in OHCA patients, yielding mixed results. While the ARREST trial demonstrated a survival benefit with ECPR, the Prague OHCA and INCEPTION trials showed varying outcomes, reflecting the complexity of patient selection and treatment strategies. Despite inherent risks and complications associated with ECPR, it may offer a potential survival advantage under optimal conditions.
Future directions in ECPR involve the development of innovative treatment protocols such as the CARL therapy, which incorporates specialized ECMO systems and tailored perfusion solutions. Early studies indicate promising outcomes with CARL therapy, emphasizing the importance of a well-coordinated and structured approach to ECPR implementation.
In summary, ECPR shows promise in improving survival rates for OHCA patients within a well-organized healthcare system. However, further research is needed to refine patient selection criteria and optimize treatment protocols, ultimately enhancing patient outcomes in cardiac arrest scenarios.
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Die Verwendung von venoarterieller extrakorporaler Membranoxygenierung (VA-ECMO) hat in der Behandlung von Herz-Kreislauf-Stillständen (OHCA) an Bedeutung gewonnen.
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ECPR (extrakorporale kardiopulmonale Reanimation) ermöglicht eine kontinuierliche Kreislaufunterstützung während der Wiederbelebung, was die Zeit für Diagnose und Therapie zugrunde liegender Ursachen verbessert.
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Die Auswahl der Patient*innen für ECPR ist entscheidend und sollte auf Faktoren wie dem Initialrhythmus, der Dauer des No-Flow- und Low-Flow-Zustands sowie dem Vorhandensein reversibler Ursachen basieren.
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Randomisierte kontrollierte Studien wie ARREST, Prague OHCA und INCEPTION haben unterschiedliche Ergebnisse zur Wirksamkeit von ECPR geliefert, was die Bedeutung einer sorgfältigen Patient*innenselektion und Behandlungsstrategie unterstreicht.
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Trotz der potenziellen Vorteile birgt die ECPR auch inhärente Risiken und Komplikationen wie vaskuläre Probleme und Gerinnungsstörungen.
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Zukünftige Entwicklungen wie die CARL-Therapie zeigen vielversprechende Ansätze zur Verbesserung der ECPR durch innovative Behandlungsprotokolle und spezialisierte ECMO-Systeme.
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Eine gut organisierte und strukturierte Herangehensweise an die ECPR-Implementierung ist entscheidend, um die Patient*innenversorgung und die postreanimationsbezogene Behandlung zu optimieren.
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Weitere Forschung ist erforderlich, um die Patient*innenauswahlkriterien zu verfeinern und Behandlungsprotokolle zu optimieren, um die Überlebenschancen und die Behandlungsergebnisse bei Herz-Kreislauf-Stillständen zu verbessern.
Publication History
Article published online:
29 April 2024
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