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Der Klinikarzt 2020; 49(05): 198-203
DOI: 10.1055/a-1159-6839
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Das akute Lungenversagen (ARDS) und Einsatzspektrum der ECMO-Unterstützung

Indikationsstellung extrakorporaler Gasaustauschsysteme
Thomas Fuehner
1   Klinik für Pneumologie, Intensiv- und Schlafmedizin, KRH Klinikum Siloah, Hannover
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Publication History

Publication Date:
12 May 2020 (online)

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ZUSAMMENFASSUNG

Über viele Jahrzehnte galt die invasive Beatmung als die letzte Eskalationsstufe intensivmedizinischer Maßnahmen für Patienten mit einem akuten Lungenversagen. In den letzten 2 Jahrzehnten kamen als weitere Maßnahmen vermehrt extrakorporale Gasaustauschsysteme „künstliche Lungen“ zum Einsatz (Extracorporeal-life-support, ECLS-Systeme). Die Anzahl der Anwendungen hat in den letzten Jahren bei schwerstkranken Patienten deutlich zugenommen, trotz einer qualitativ geringen wissenschaftlichen Datenlage. Befürworter des Verfahrens betonen, dass es sich um ein Lungenersatzverfahren handelt und um keine Therapie im eigentlichen Sinne. Damit wird auf die sensible Indikationsstellung hingewiesen, die das vermeintliche Regenerationspotenzial des akuten Lungenversagens richtig einschätzen muss. Ein häufiges Problem von klinischen Studien im Bereich der Intensivmedizin ist das heterogene Patientenkollektiv. Die meisten Intensivpatienten sind hochkomplex erkrankt, sodass entweder die Kohorten sehr klein sind oder doch eine Verzerrung diskutiert werden muss. Dieses Problem hatten bisher natürlich auch ECMO-Studien. Die aktuell ablaufende SARS-Coronavirus-2-Pandemie bietet eventuell die Gelegenheit einer homogenen ARDS-Patientengruppe. Extrakorporale Gasaustauschsysteme sollten in spezialisierten Zentren mit ausreichender Erfahrung angewendet werden für eine kritische Indikationsstellung und eine möglichst komplikationsarme technische Durchführung.

 

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