Skip to main content
SpringerLink
Log in

Extrakorporale Membranoxygenierung (ECMO)

Gibt es noch Indikationen? – Erfahrungen aus dem ECMO-Zentrum Mannheim

Extracorporeal membrane oxygenation (ECMO)

Are there still indications? – Experiences from the ECMO Center Mannheim

  • Leitthema
  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Kinder, die künstlich beatmet werden müssen, stellen eine Risikogruppe mit hoher Morbidität und Mortalität dar. Schonendere konventionelle Beatmung sowie die Hochfrequenzoszillationsventilation und die Einführung neuerer Behandlungsverfahren, z. B. die Therapie mit Surfactant oder Stickstoffmonoxid, erbrachten einige Verbesserungen. Dennoch ist die extrakorporale Membranoxygenierung (ECMO) eine lebensrettende Technologie für diejenigen Patienten mit Lungenversagen, bei denen die maximale klinische Therapie nicht greift. Das therapeutische Management und die Auswahlkriterien für ECMO bei Kindern werden ausgehend von den erworbenen und angeborenen Krankheiten, die zu einem akuten Atemnotsyndromsyndrom (ARDS) führen können, aufgezeigt.

Abstract

Children who require mechanical ventilation represent a high risk population with high morbidity and mortality. Experienced handling of conventional therapies, including high frequency oscillation ventilation and initiation of newer treatment options, such as therapy with surfactant or nitric oxide has led to some improvements. Nevertheless, extracorporeal membrane oxygenation (ECMO) is a life-saving technology for patients with respiratory failure refractory to maximum medical therapy. This article demonstrates the clinical management and selection criteria for ECMO in childhood contributing to the incidence and of acquired or inborn diseases which may lead to acute respiratory distress syndrome (ARDS).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342:1301–1308

    Article  Google Scholar 

  2. Adhikari NK, Burns KE, Friedrich JO et al (2007) Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ 334:779

    Article  PubMed  Google Scholar 

  3. Buesing KA, Kilian AK, Schaible T et al (2007) Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia: follow-up MRI evaluating carotid artery reocclusion and neurologic outcome. AJR Am J Roentgenol 188(6):1636–1642

    Article  PubMed  Google Scholar 

  4. Bui KC, Senadheera D, Wang X et al (2010) Recovery of multipotent progenitors from the peripheral blood of patients requiring extracorporeal membrane oxygenation support. Am J Respir Crit Care Med 181(3):226–237

    Article  PubMed  Google Scholar 

  5. Clark RH (2005) The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol 25:251–257

    Article  PubMed  Google Scholar 

  6. Curley MA, Hibberd PL, Fineman LD et al (2005) Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA 294:229–237

    Article  PubMed  CAS  Google Scholar 

  7. Dellinger RP, Levy MM, Carlet JM et al (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med 36(1):296–327

    Article  PubMed  Google Scholar 

  8. Duffett M, Choong K, Ng V et al (2007) Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis. Crit Care 11:R66

    Article  PubMed  Google Scholar 

  9. Erickson S, Schibler A, Numa A et al (2007) Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med 8(4):317–323

    Article  PubMed  Google Scholar 

  10. Extracorporeal Life Support Organization (2010) ECLS registry report. ELSO, Ann Arbor

  11. Extracorporeal Life Support Organization (2010) ECMO-registry. ELSO, Ann Arbor

  12. Gupta M, Shanley TP, Moler FW (2008) Extracorporeal life support for severe respiratory failure in children with immune compromised conditions. Pediatr Crit Care Med 9(4):380–385

    Article  PubMed  Google Scholar 

  13. Hout L van den, Schaible T, Cohen-Overbeek TE et al (2011) Actual outcome in infants with congenital diaphragmatic hernia: the role of a standardized postnatal treatment protocol. Fetal Diagn Ther 29(1):55–63

    Article  PubMed  Google Scholar 

  14. Kachel W, Schaible T (2004) ECMO beim Neugeborenen. In: Rieger C, Hardt H von der, Sennhauser SH et al (Hrsg) Pädiatrische Pneumologie, 2. Aufl. Springer, Berlin Heidelberg New York

  15. Keller RL, Tacy TA, Hendricks-Munoz K et al (2010) Congenital diaphragmatic hernia: endothelin-1, pulmonary hypertension, and disease severity. Am J Respir Crit Care Med 182:555e61

    Article  Google Scholar 

  16. Lacroix J, Hebert PC, Hutchison JS et al (2007) Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 356:1609–1619

    Article  PubMed  CAS  Google Scholar 

  17. Lotze A, Mitchell BR, Bulas DI et al (1998) Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. Survanta in Term Infants Study Group. J Pediatr 132(1):40–47

    Article  PubMed  CAS  Google Scholar 

  18. Mc Nally H, Bennett CC, Elbourne D et al (2006) United Kingdom collaborative randomized trial of neonatal extracorporeal membrane oxygenation: follw-up to age 7 years. Pediatrics 117(5):e 845–e854

    Google Scholar 

  19. Moerer O, Quintel M (2011) Protective and ultra-protective ventilation: using pumpless interventional lung assist (iLA). Minerva Anestesiol 77(5):537–544

    PubMed  CAS  Google Scholar 

  20. Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138(3):720–723

    PubMed  CAS  Google Scholar 

  21. Peek GJ, Mugford M, Tiruvoipati R et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374(9698):1351–1363

    Article  PubMed  Google Scholar 

  22. Peter JV, John P, Graham PL et al (2008) Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ 336:1006–1009

    Article  PubMed  Google Scholar 

  23. Petrucci N, Iacovelli W (2007) Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev 18(3):CD003844

    Google Scholar 

  24. Randolph AG (2009) Management of acute lung injury and acute respiratory distress syndrome in children. Crit Care Med 37(8):2448–2454

    Article  PubMed  Google Scholar 

  25. Roy BJ, Rycus P, Conrad SA, Clark RH (2000) The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the Extracorporeal Life Support Organization (ELSO) Registry. Pediatrics 106(6):1334–1338

    Article  PubMed  CAS  Google Scholar 

  26. Santschi M, Jouvet P, Leclerc F et al (2010) Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med 11:681–689

    Article  PubMed  Google Scholar 

  27. Schaible T, Hermle D, Loersch F et al (2010) A 20-year experience on neonatal extracorporeal membrane oxygenation in a referral center. Intensive Care Med 36(7):1229–1234

    Article  PubMed  CAS  Google Scholar 

  28. Sud S, Sud M, Friedrich JO et al (2010) High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis. BMJ 340:c2327

    Article  PubMed  Google Scholar 

  29. The Neonatal Inhaled Nitric Oxide Study Group (2000) Inhaled nitric oxide in term and near-term infants: neurodevelopmental follw-up of the neonatal inhaled nitric oxide study group (NINOS). J Pediatr 136(5):611–617

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Kinderheilkunde und Jugendmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    T. Schaible

Authors
  1. T. Schaible
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Schaible.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schaible, T. Extrakorporale Membranoxygenierung (ECMO) . Monatsschr Kinderheilkd 159, 948–954 (2011). https://doi.org/10.1007/s00112-011-2421-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00112-011-2421-7

Schlüsselwörter

Keywords

Search

Navigation