Extrakorporale Membranoxygenierung als „Bridge-to-recovery“ bei infarktbedingtem therapierefraktärem Rechtsherzversagen

 

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Zusammenfassung

Anamnese und klinischer Befund: Ein 41-jähriger Mann wurde unter Reanimationsbedingungen und der Arbeitsdiagnose eines akuten Hinterwandinfarktes in unser Herzzentrum aufgenommen.

Untersuchungen: Die Notfallherzkatheteruntersuchung zeigte einen thrombotischen Verschluss der mittleren rechten Koronararterie. Nach erfolgreicher perkutaner Koronarrevaskularisation konnte eine hämodynamische Stabilisierung erreicht und der Patient auf die Intensivstation (ITS) verlegt werden.

Therapie und klinischer Verlauf: Postinterventionell wurde der Patient erneut reanimationspflichtig, so dass aufgrund eines therapierefraktären akuten Rechtsherzversagens nach interdisziplinärer Diskussion im Herzteam für die Anlage eines extrakorporalen Unterstützungssystems (ECMO) auf der ITS unter kontinuierlicher Reanimation (CPR) entschieden wurde. Nach dreitägiger ECMO-Therapie zeigte sich eine rasche hämodynamische und klinische Stabilisierung, so dass der Patient bereits am 7. postinterventionellen Tag extubiert und auf die Intermediate-Care-Station verlegt werden konnte.

Folgerung: Die extrakorporale Unterstützungstherapie ist eine effektive Methode zur überbrückenden Kreislaufunterstützung bei Patienten mit ischämiebedingtem therapierefraktären Rechtsherzsagen nach erfolgreicher Reperfusionstherapie.

Abstract

History and clinical findings: We present a 41-year-old man with cardiac arrest in need of cardiopulmonary resuscitation (CPR) with the diagnosis of a posterior wall infarction, who was hospitalized in our cardiac centre.

Investigations: The cardiac catheterization showed a thrombotic obstruction of the right coronary artery. After percutaneous coronary revascularization a hemodynamically stable situation could be achieved and the patient was admitted to the intensive care unit (ICU).

Treatment and clinical course: The patient became again hemodynamically unstable and a CPR was required. Based on the acute right heart failure with therapy refractory cardiogenic shock we decided within our heart team for an extra corporeal membrane oxygenation (ECMO) applied during CPR in the ICU. The extracorporeal support was needed for three days. Seven days after the emergency cardiac catheterization the patient was extubated and transferred to our intermediate care.

Conclusion: Extracorporeal life support is feasible und effective for bridging therapy in patients with acute ischemic right heart failure with refractory cardiogenic shock and successful reperfusion therapy.

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