Extrakorporale Verfahren in der Lungentransplantation und darüber hinaus

Zusammenfassung

Die Lungentransplantation stellt bei Patient*innen mit Lungenerkrankungen im Endstadium oft die einzige und letzte Behandlungsoption dar. In den letzten Jahren konnten die Ergebnisse nach Lungentransplantation stetig verbessert werden, nicht zuletzt wegen der technischen Entwicklungen im Bereich der Lungenersatzverfahren. Extrakorporale Gasaustauschverfahren sind heute integraler Bestandteil des klinischen Alltags und insbesondere an Lungentransplantationszentren. Der Ersatz reicht von relativ einfachen, pumpenlosen Membranen bis hin zu aufwendigen Kanülierungsarten und Gerätekonfigurationen. Insbesondere bei der extrakorporalen Membranoxygenierung (ECMO) unterscheidet man eine Reihe von Konfigurationen, die in der Thoraxchirurgie und speziell bei der Lungentransplantation Anwendung finden. Des Weiteren kann man hier zwischen der präoperativen ECMO, dem sog. Bridge-to-Transplant, sowie der intraoperativen ECMO-Unterstützung während der Transplantation unterscheiden. Diese hat in den letzten Jahren die Herz-Lungen-Maschine weitgehend verdrängt. Auch unmittelbar postoperativ spielt die ECMO bei Verhinderung und Therapie der primären Graft-Dysfunktion eine entscheidende Rolle. Neben der Lungentransplantation finden die extrakorporalen Unterstützungssysteme auch bei erweiterten thoraxchirurgischen Resektionen oder Eingriffen an den zentralen Atemwegen Anwendung. Auch zukünftig werden extrakorporale Verfahren durch die technischen Weiterentwicklungen und Verbesserungen in den Behandlungsprotokollen eine Schlüsselrolle in der Versorgung thoraxchirurgischer Patient*innen spielen.

Abstract

Lung transplantation is often the sole and final therapeutic option for patients with end-stage lung disease. In recent years, clinical outcomes have steadily improved, driven in part by advancements in extracorporeal mechanical support. These techniques have become an integral component of routine clinical practice, particularly in lung transplantation centres. Extracorporeal lung support systems range from relatively simple pumpless devices to complex cannulation techniques and device configurations. In particular, extracorporeal membrane oxygenation (ECMO) encompasses various configurations widely utilised in thoracic surgery, especially in lung transplantation. A distinction can be made between preoperative ECMO, referred to as bridge-to-transplant, and intraoperative ECMO support, which is employed during the transplantation procedure. In recent years, intraoperative ECMO has largely replaced the traditional heart-lung machine. Additionally, ECMO plays a critical role in the immediate postoperative period, both in preventing and managing primary graft dysfunction. Beyond lung transplantation, extracorporeal life support systems are also applied in complex thoracic surgical resections and procedures involving the central airways. In the future, technical advancements and improvements in treatment protocols are expected to further enhance the role of extracorporeal mechanical support in the management of thoracic surgical patients.

Schlüsselwörter

Lungentransplantation - extrakorporale Membranoxygenierung - Atemwegschirurgie

Keywords

lung transplantation - extracorporale membrane oxygenation - airway surgery

Publikationsverlauf

Eingereicht: 02. Januar 2025

Angenommen: 13. Februar 2025

Artikel online veröffentlicht:
07. April 2025

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