Empfehlungen der S3-Leitlinie (AWMF) Einsatz der extrakorporalen
                    Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen

Alexander Assmann; Andreas Beckmann; Christof Schmid; Karl Werdan; Guido Michels; Oliver Miera; Florian Schmidt; Stefan Klotz; Christoph Starck; Kevin Pilarczyk; Ardawan Rastan; Marion Burckhardt; Monika Nothacker; Ralf Muellenbach; York Zausig; Nils Haake; Heinrich Groesdonk; Markus Ferrari; Michael Buerke; Marcus Hennersdorf; Mark Rosenberg; Thomas Schaible; Harald Köditz; Stefan Kluge; Uwe Janssens; Matthias Lubnow; Andreas Flemmer; Susanne Herber-Jonat; Lucas Wessel; Dirk Buchwald; Sven Maier; Lars Krüger; Andreas Fründ; Rolf Jaksties; Stefan Fischer; Karsten Wiebe; Christiane Hartog; Omer Dzemali; Daniel Zimpfer; Elfriede Ruttmann-Ulmer; Christian Schlensak; Stephan Ensminger; Malte Kelm; Udo Boeken

doi:10.1055/a-1734-4157

Aktuelle Kardiologie, Inhaltsverzeichnis

Aktuelle Kardiologie 2022; 11(04): 358-366
DOI: 10.1055/a-1734-4157

Originalarbeit

Empfehlungen der S3-Leitlinie (AWMF) Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen

Recommendations of the S3 Guideline Use of Extracorporeal Circulation (ECLS/ECMO) for Cardiac and Circulatory Failure

Alexander Assmann

¹Department of Cardiac Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany

,

Andreas Beckmann

²German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany

,

Christof Schmid

³Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany

,

Karl Werdan

⁴Clinic for Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany

,

Guido Michels

⁵Department of Acute and Emergency Care, St. Antonius Hospital Eschweiler, Eschweiler, Germany

,

Oliver Miera

⁶Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany

,

Florian Schmidt

⁷Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany

,

Stefan Klotz

⁸Department of Cardiac Surgery, Segeberger Kliniken Bad Segeberg, Bad Segeberg, Germany

,

Christoph Starck

⁹Department of Cardiothoracic & Vascular Surgery, German Heart Centre, Berlin, Deutschland

,

Kevin Pilarczyk

¹⁰Department for Intensice Care Medicine, Imland Hospital Rendsburg, Rendsburg, Germany

,

Ardawan Rastan

¹¹Department of Cardiac and Vascular Thoracic Surgery, Philipps-University Hospital Marburg, Marburg, Germany

,

Marion Burckhardt

¹²Department of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University (DHBW)-Stuttgart, Stuttgart, Germany

,

Monika Nothacker

¹³Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Germany

,

Ralf Muellenbach

¹⁴Department of Anaesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany

,

York Zausig

¹⁵Department of Anesthesiology and Operative Intensive Care Medicine, Aschaffenburg-Alzenau Hospital, Aschaffenburg, Germany

,

Nils Haake

¹⁰Department for Intensice Care Medicine, Imland Hospital Rendsburg, Rendsburg, Germany

,

Heinrich Groesdonk

¹⁶Department of Intensive Care Medicine, Helios Clinic Erfurt, Erfurt, Germany

,

Markus Ferrari

¹⁷HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden, Germany

,

Michael Buerke

¹⁸Department of Cardiology, Angiology and Internal Intensive Care Medicine, St. Marienkrankenhaus Siegen, Siegen, Germany

,

Marcus Hennersdorf

¹⁹Department of Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine, SLK-Kliniken Heilbronn, Heilbronn, Germany

,

Mark Rosenberg

²⁰Medizinische Klinik I, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany

,

Thomas Schaible

²¹Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Heidelberg, Germany

,

Harald Köditz

²²Medical University Children's Hospital Hannover, Hannover, Germany

,

Stefan Kluge

²³Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg

,

Uwe Janssens

²⁴Medical Clinic and Medical Intensive Care Medicine, St. Antonius Hospital, Eschweiler, Germany

,

Matthias Lubnow

²⁵Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany

,

Andreas Flemmer

²⁶Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, München, Germany

,

Susanne Herber-Jonat

²⁶Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, München, Germany

,

Lucas Wessel

²⁷Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Deutschland

,

Dirk Buchwald

²⁸Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany

,

Sven Maier

²⁹Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany

,

Lars Krüger

³⁰Division of Thoracic and Cardiovascular Surgery, Heart- and Diabetescentre NRW, Ruhr-University Bochum, Bochum, Germany

,

Andreas Fründ

³¹Department of Physiotherapy, Heart- and Diabetescentre NRW, Ruhr-University Bochum, Bochum, Germany

,

Rolf Jaksties

³²German Heart Foundation, Berlin, Germany

,

Stefan Fischer

³³Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany

,

Karsten Wiebe

³⁴Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany

,

Christiane Hartog

³⁵Department of Anesthesiology and Operative Intensive Care Medicine, Charité, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

,

Omer Dzemali

³⁶Department of Cardiac Surgery, Triemli City Hospital Zurich, Zürich, Switzerland

,

Daniel Zimpfer

³⁷Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria

,

Elfriede Ruttmann-Ulmer

³⁸Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria

,

Christian Schlensak

³⁹Department of Cardio-Thoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany

,

Stephan Ensminger

⁴⁰Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany

,

Malte Kelm

⁴¹Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Medical School, Düsseldorf, Germany

,

Udo Boeken

¹Department of Cardiac Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany

› Institutsangaben

Abstract

Zusammenfassung

In den vergangenen Jahren hat der Einsatz mechanischer Unterstützungssysteme für Patienten mit Herz- und Kreislaufversagen kontinuierlich zugenommen, sodass in Deutschland mittlerweile jährlich etwa 3000 ECLS/ECMO-Systeme implantiert werden. Vor dem Hintergrund bislang fehlender umfassender Leitlinien bestand ein dringlicher Bedarf an der Formulierung evidenzbasierter Empfehlungen zu den zentralen Aspekten der ECLS/ECMO-Therapie.

Im Juli 2015 wurde daher die Erstellung einer S3-Leitlinie durch die Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) bei der zuständigen Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) angemeldet. In einem strukturierten Konsensusprozess mit Einbindung von Experten aus Deutschland, Österreich und der Schweiz, delegiert aus 11 AWMF-Fachgesellschaften, 5 weiteren Fachgesellschaften sowie der Patientenvertretung, entstand unter Federführung der DGTHG die Leitlinie „Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen“, die im Februar 2021 publiziert wurde.

Die Leitlinie fokussiert auf klinische Aspekte der Initiierung, Fortführung, Entwöhnung und Nachsorge und adressiert hierbei auch strukturelle und ökonomische Fragestellungen. Dieser Artikel präsentiert eine Übersicht zu der Methodik und den konsentierten Empfehlungen.

Abstract

In recent years, the use of mechanical support for patients with cardiac or circulatory failure has continuously increased, leading to 3000 ECLS/ECMO (extracorporeal life support/extracorporeal membrane oxygenation) implantations annually in Germany. Due to the lack of guidelines, an urgent need for evidence-based recommendations addressing the central aspects of ECLS/ECMO therapy has existed.

In July 2015, the generation of a guideline level S3 according to the standards of the Association of the Scientific Medical Societies in Germany (AWMF) was announced by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS). In a well-structured consensus process, involving experts from Germany, Austria and Switzerland, delegated by 16 scientific societies and the patients’ representation, the guideline “Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure” was created under guidance of the GSTCVS, and published in February 2021.

The guideline focuses on clinical aspects of initiation, continuation, weaning and aftercare, herein also addressing structural and economic issues. This article presents an overview on the methodology as well as the final recommendations.

Schlüsselwörter

Leitlinie - Extrakorporale Membranoxygenierung (ECMO) - Extracorporeal Life Support (ECLS) - Herz-Kreislauf-Versagen

Keywords

guideline - extracorporeal membrane oxygenation (ECMO) - extracorporeal life support (ECLS) - cardiac and circulatory failure

Volltext

Referenzen

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