Zusammenfassung
Komplikationen an der ECMO sind die Regel und nicht die Ausnahme. Es werden mechanische und patientenbezogene Komplikationen differenziert. Mechanische Komplikationen stehen in direktem Zusammenhang mit der ECMO-Apparatur (z. B. Oxygenatorthrombosen). Die Behebung der mechanischen Komplikation besteht in der Regel aus dem Austausch der Komponente. Patientenbezogene Komplikationen sind alle Komplikationen eines kritisch kranken Intensivpatienten. Patientenbezogene Komplikationen sind weitaus häufiger als mechanische Komplikationen und auch schwieriger zu beheben. Zu den häufigsten patientenbezogenen Komplikationen zählen Blutungen jeder Art. Die differenzierte Hypoxämie oder das Harlekin-Syndrom kann zu deletären neurologischen Folgen führen und leicht übersehen werden. Eine viel diskutierte Komplikation an der venoarteriellen (VA-)ECMO ist die linksventrikuläre Distension. Verschiedene Verfahren zur Minimierung und „unloading“ des linken Ventrikels existieren. Eine der häufigsten angewendeten Methoden ist die IABP in Kombination mit der VA-ECMO. Zurzeit populär scheint die eher kostspielige Kombination der VA-ECMO mit einer Impella, was von den Anwendern ECPELLA-Therapie tituliert wird. In der Theorie ist ein „unloading“ für die Erholung des linken Ventrikels essenziell. Trotzdem fehlt der Nachweis, dass ein generelles „unloading“ auch tatsächlich zu einem verbesserten Outcome führt. „Unloading“ wird erforderlich, wenn es zu einem therapierefraktären Lungenödem kommt. Dieses Kapitel gibt einen Überblick über die häufigsten Komplikationen und die Möglichkeiten der Behebung. Eine permanente Schulung der Anwender führt zu einer notwendigen Routine für das Komplikationsmanagement.
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Camboni, D., Schmid, C. (2020). Komplikationen der venoarteriellen ECMO-Therapie. In: Boeken, U., Assmann, A., Klotz, S., Born, F., Rieth, A., Schmid, C. (eds) Mechanische Unterstützung im akuten Kreislaufversagen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59901-3_11
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