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Medizinische Klinik - Intensivmedizin und Notfallmedizin

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02.07.2018 | Kardiogener Schock | Positionspapier

Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR)

Konsensuspapier der DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI und GRC

verfasst von: Prof. Dr. G. Michels, Dr. T. Wengenmayer, Prof. Dr. C. Hagl, Prof. Dr. C. Dohmen, Prof. Dr. B. W. Böttiger, Prof. Dr. J. Bauersachs, Prof. Dr. A. Markewitz, A. Bauer, Prof. Dr. J.-T. Gräsner, Prof. Dr. R. Pfister, Prof. Dr. A. Ghanem, Prof. Dr. H.-J. Busch, Prof. Dr. U. Kreimeier, Dr. A. Beckmann, Prof. Dr. M. Fischer, Prof. Dr. C. Kill, Prof. Dr. U. Janssens, Prof. Dr. S. Kluge, F. Born, Prof. Dr. H. M. Hoffmeister, PD Dr. M. Preusch, Prof. Dr. U. Boeken, Prof. Dr. R. Riessen, Prof. Dr. H. Thiele

Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin | Ausgabe 6/2018

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Zusammenfassung

Die extrakorporale kardiopulmonale Reanimation („extracorporeal cardiopulmonary resuscitation“, eCPR) kann als Rettungsversuch für hoch selektierte Patienten mit refraktärem Herz-Kreislauf-Stillstand und potenziell reversibler Ätiologie erwogen werden. Aktuell fehlen randomisiert-kontrollierte Studien zur eCPR und es existieren keine validen Prädiktoren für Nutzen und Risiko, die bei der Indikationsstellung hilfreich sein könnten. Die bisherigen Selektionskriterien und Abläufe sind klinikspezifisch und ein (nationaler) standardisierter Algorithmus fehlt. Das vorliegende Konsensuspapier bietet basierend auf einer konsentierten Expertenmeinung den Vorschlag für ein standardisiertes Vorgehen bei eCPR.

Atwood C, Eisenberg MS, Herlitz J, Rea TD (2005) Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 67(1):75–80 CrossRefPubMed

Go AS, Mozaffarian D, Roger VL et al (2014) Executive summary: heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation 129(3):399–410 CrossRefPubMed

Hawkes C, Booth S, Ji C et al (2017) Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 110:133–140 CrossRefPubMed

Spangenberg T, Schewel J, Dreher A et al (2018) Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest. Resuscitation 127:73–78 CrossRefPubMed

Kuisma M, Alaspää A (1997) Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome. Eur Heart J 18(7):1122–1128 CrossRefPubMed

Hess EP, Campbell RL, White RD (2007) Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 72(2):200–206 CrossRefPubMed

Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: Incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245 CrossRefPubMed

Link MS, Berkow LC, Kudenchuk PJ et al (2015) Part 7: advanced cardiovascular life support – 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(Suppl 2):S444–S464 CrossRefPubMed

Karam N, Marijon E, Dumas F et al (2017) Characteristics and outcomes of out-of-hospital sudden cardiac arrest according to the time of occurrence. Resuscitation 116:16–21 CrossRefPubMed

10.

Soar J, Nolan JP, Böttiger BW et al (2015) European Resuscitation Council guidelines for resuscitation 2015 Section 3. Adult advanced life support. Resuscitation 95:100–147 CrossRefPubMed

11.

Kim SJ, Kim HJ, Lee HY et al (2016) Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: a meta-analysis. Resuscitation 103:106–116 CrossRefPubMed

12.

Vdovin N, Günther SPW, de Waha S et al (2017) Early risk stratification in patients with cardiogenic shock complicating acute myocardial infarction treated with extracorporeal life support and primary percutaneous coronary intervention. JACC Cardiovasc Interv 10(23):2469–2471 CrossRefPubMed

13.

Chen YS, Lin JW, Yu HY et al (2008) Cardiopulmonary resuscitation with assisted extracorporeal life support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372:554–561 CrossRefPubMed

14.

Wang CH, Chou NK, Becker LB et al (2014) Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – a comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation 85(9):1219–1224 CrossRefPubMed

15.

Fagnoul D, Combes A, De Backer D (2014) Extracorporeal cardiopulmonary resuscitation. Curr Opin Crit Care 20(3):259–265 CrossRefPubMed

16.

Blumenstein J, Leick J, Liebetrau C et al (2016) Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: a propensity-matched analysis. Eur Heart J Acute Cardiovasc Care 5(7):13–22 CrossRefPubMed

17.

Spangenberg T, Meincke F, Brooks S et al (2016) „Shock and Go?“ extracorporeal cardio-pulmonary resuscitation in the golden-hour of ROSC. Catheter Cardiovasc Interv 88(5):691–696 CrossRefPubMed

18.

Combes A, Brodie D, Chen YS et al (2017) The ICM research agenda on extracorporeal life support. Intensive Care Med 43(9):1306–1318 CrossRefPubMed

19.

Debaty G, Babaz V, Durand M et al (2017) Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation 112:1–10 CrossRefPubMed

20.

Conrad SA, Rycus PT (2017) Extracorporeal membrane oxygenation for refractory cardiac arrest. Ann Card Anaesth 20(Supplement):S4–S10 CrossRefPubMedPubMedCentral

21.

Richardson AS, Schmidt M, Bailey M et al (2017) ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation 112:34–40 CrossRefPubMed

22.

Haas NL, Coute RA, Hsu CH et al (2017) Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-an ELSO registry study. Resuscitation 119:56–62 CrossRefPubMedPubMedCentral

23.

Ouweneel DM, Schotborgh JV, Limpens J et al (2016) Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 42:1922–1934 CrossRefPubMedPubMedCentral

24.

Trummer G, Bein B, Buerke M et al (2011) Standardized terminology of mechanical heart, lung and circulatory assist devices: a recommendation of the section „heart and circulation“ of the German Interdisciplinary Association of Critical Care Medicine. Appl Cardiopulm Pathophysiol 15:181–182

25.

ELSO (2013) ECPR supplement to the ELSO general guidelines. Version 1.3 ( https://www.elso.org/Portals/0/IGD/Archive/FileManager/6713186745cusersshyerdocumentselsoguidelinesforecprcases1.3.pdf)

26.

Günther S, Born F, Buchholz S et al (2018) Patienten unter Reanimation: Kandidaten für „Extracorporeal Life Support“? Z Herz Thorax Gefäßchir 32:133–140 CrossRef

27.

Wengenmayer T, Rombach S, Ramshorn F et al (2017) Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care 21(1):157 CrossRefPubMedPubMedCentral

28.

Kuroki N, Abe D, Iwama T et al (2017) Association between delay to coronary reperfusion and outcome in patients with acute coronary syndrome undergoing extracorporeal cardiopulmonary resuscitation. Resuscitation 114:1–6 CrossRefPubMed

29.

Abrams D, Garan AR, Abdelbary A et al (2018) Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med. https://doi.org/10.1007/s00134-018-5064-5 CrossRefPubMed

30.

Yannopoulos D, Bartos JA, Raveendran G et al (2017) Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest. J Am Coll Cardiol 70(9):1109–1117 CrossRefPubMed

31.

Hayashida K, Suzuki M, Yonemoto N et al (2017) Early lactate clearance is associated with improved outcomes in patients with postcardiac arrest syndrome: a prospective, multicenter observational study (SOS-KANTO 2012 study). Crit Care Med 45(6):e559–e566 CrossRefPubMed

32.

Slottosch I, Liakopoulos O, Kuhn E et al (2017) Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock. J Crit Care 42:35–41 CrossRefPubMed

33.

Momiyama Y, Yamada W, Miyata K et al (2017) Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest. Acute Med Surg 4(1):25–30 CrossRefPubMed

34.

Zeserson E, Goodgame B, Hess JD et al (2018) Correlation of venous blood gas and pulse oximetry with arterial blood gas in the undifferentiated critically ill patient. J Intensive Care Med 33(3):176–181 CrossRefPubMed

35.

Siegenthaler W (2005) Differentialdiagnose, 19. Aufl. Thieme, Stuttgart

36.

Geisler AC, Söffker G, Breunig F et al (2014) Der besondere Fall-Optimale Rettungskette. Hamb Arztebl 68(10):44–46

37.

Hohmann C, Pfister R, Michels G (2018) Are the initial pH and the lactate values after cardiopulmonary resuscitation always crucial? Med Klin Intensivmed Notfmed. https://doi.org/10.1007/s00063-018-0432-z PubMedCrossRef

38.

Shin J, Lim YS, Kim K et al (2017) Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study. Crit Care 21(1):322 CrossRefPubMedPubMedCentral

39.

Gil E, Na SJ, Ryu JA et al (2017) Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation. PLoS ONE 12(4):e176143 CrossRefPubMedPubMedCentral

40.

Kang SB, Kim KS, Suh GJ et al (2017) Long-term survival of out-of-hospital cardiac arrest patients with malignancy. Am J Emerg Med 35(10):1457–1461 CrossRefPubMed

41.

Sulzgruber P, Sterz F, Poppe M et al (2017) Age-specific prognostication after out-of-hospital cardiac arrest - the ethical dilemma between „life-sustaining treatment“ and „the right to die“ in the elderly. Eur Heart J Acute Cardiovasc Care 6(2):112–120 CrossRefPubMed

42.

Pabst D, El-Banayosy A, Soleimani B, Brehm CE (2018) Predictors of survival for nonhighly selected patients undergoing resuscitation with extracorporeal membrane oxygenation after cardiac arrest. ASAIO J 64(3):368–374 CrossRefPubMed

43.

Lorusso R, Gelsomino S, Parise O et al (2017) Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock in elderly patients: trends in application and outcome from the Extracorporeal Life Support Organization (ELSO) Registry. Ann Thorac Surg 104(1):62–69 CrossRefPubMed

44.

Riggs KR, Becker LB, Sugarman J (2015) Ethics in the use of extracorporeal cardiopulmonary resuscitation in adults. Resuscitation 91:73–75 CrossRefPubMedPubMedCentral

45.

Mancini ME, Diekema DS, Hoadley TA et al (2015) Part 3: ethical issues: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(18 Suppl 2):S383–S396 CrossRefPubMed

46.

Meltzer EC, Ivascu NS, Stark M et al (2016) A survey of physicians’ attitudes toward decision-making authority for initiating and withdrawing VA-ECMO: results and ethical implications for shared decision making. J Clin Ethics 27(4):281–289 PubMedPubMedCentral

47.

Makdisi T, Makdisi G (2017) Extra-corporeal membrane oxygenation support: ethical dilemmas. Ann Transl Med 5(5):112 CrossRefPubMedPubMedCentral

48.

Niecke A, Schneider G, Hartog CS, Michels G (2017) Traumatized relatives of intensive care patients. Med Klin Intensivmed Notfmed 112(7):612–617 CrossRefPubMed

49.

Michels G, Thiele H, Kluge S, Pfister R (2017) Are there any prognostic predictors for extracorporeal cardiopulmonary resuscitation (ECPR) in case of out-of-hospital cardiac arrest? Med Klin Intensivmed Notfmed 112(7):634–636 CrossRefPubMed

50.

Stiell IG, Nichol G, Leroux BG et al (2011) Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. N Engl J Med 365(9):787–797 CrossRefPubMedPubMedCentral

51.

Goslar T, Knafelj R, Radsel P et al (2016) Emergency percutaneous implantation of veno-arterial extracorporeal membrane oxygenation in the catheterisation laboratory. EuroIntervention 12(12):1465–1472 CrossRefPubMed

52.

Kashiura M, Sugiyama K, Tanabe T, Akashi A, Hamabe Y (2017) Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a retrospective observational study. BMC Anesthesiol 17(1):4 CrossRefPubMedPubMedCentral

53.

Voicu S, Henry P, Malissin I et al (2018) Improving cannulation time for extracorporeal life support in refractory cardiac arrest of presumed cardiac cause – comparison of two percutaneous cannulation techniques in the catheterization laboratory in a center without on-site cardiovascular surgery. Resuscitation 122:69–75 CrossRefPubMed

54.

Reynolds JC, Callaway CW, El Khoudary SR et al (2009) Coronary angiography predicts improved outcome following cardiac arrest: propensity-adjusted analysis. J Intensive Care Med 24(3):179–186 CrossRefPubMedPubMedCentral

55.

Dumas F, Cariou A, Manzo-Silberman S et al (2010) Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Circ Cardiovasc Interv 3(3):200–207 CrossRefPubMed

56.

Kragholm K, Malta Hansen C, Dupre ME et al (2017) Direct transport to a percutaneous cardiac intervention center and outcomes in patients with out-of-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes 10(6):e3414. https://doi.org/10.1161/CIRCOUTCOMES.116.003414 CrossRefPubMed

57.

Scholz KH, Andresen D, Böttiger BW et al (2017) Quality indicators and structural requirements for cardiac arrest centers-German Resuscitation Council (GRC). Kardiologe 11:205–208 CrossRef

58.

Jarosz A, Darocha T, Kosiński S et al (2017) Profound accidental hypothermia: systematic approach to active recognition and treatment. ASAIO J 63(3):e26–e30 CrossRefPubMedPubMedCentral

59.

Beckmann A, Benk C, Beyersdorf F et al (2011) Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg 40(3):676–680 PubMed

60.

Combes A, Brodie D, Bartlett R et al (2014) Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med 190(5):488–496 CrossRefPubMed

61.

Dirnberger D, Fiser R, Harvey C et al (2015) Extracorporeal Life Support Organization (ELSO), guidelines for ECMO transport. https://www.elso.org/resources/guidelines.aspx

62.

Broman LM, Frenckner B (2016) Transportation of critically ill patients on extracorporeal membrane oxygenation. Front Pediatr 4:63 CrossRefPubMedPubMedCentral

63.

Michels G, Zinke H, Möckel M et al (2017) Recommendations for education in ultrasound in medical intensive care and emergency medicine: position paper of DGIIN, DEGUM and DGK. Med Klin Intensivmed Notfmed 112(4):314–319 CrossRefPubMed

64.

Zhang Z (2017) Echocardiography for patients undergoing extracorporeal cardiopulmonary resuscitation: a primer for intensive care physicians. J Intensive Care 5:15 CrossRefPubMedPubMedCentral

65.

Price S, Platz E, Cullen L et al (2017) Expert consensus document: echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol 14(7):427–440 CrossRefPubMedPubMedCentral

66.

Nolan JP, Hazinski MF, Aickin R et al (2015) Part 1: executive summary: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 95:e1–e31 CrossRefPubMed

67.

Olasveengen TM, de Caen AR, Mancini ME et al (2017) 2017 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Circulation 136(23):e424–e440 CrossRefPubMed

68.

Perkins GD, Olasveengen TM, Maconochie I et al (2018) European Resuscitation Council guidelines for resuscitation: 2017 update. Resuscitation 123:43–50 CrossRefPubMed

69.

Swol J, Belohlávek J, Haft JW et al (2016) Conditions and procedures for in-hospital extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR) of adult patients. Perfusion 31(3):182–188 CrossRefPubMed

70.

Leick J, Liebetrau C, Szardien S et al (2013) Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol 102(9):661–669 CrossRefPubMed

71.

Nanjayya VB, Murphy D (2015) Ultrasound guidance for extra-corporeal membrane oxygenation general guidelines ( https://www.elso.org/Portals/0/Files/elso_Ultrasoundguideance_ecmogeneral_guidelines_May2015.pdf)

72.

Ahn HJ, Lee JW, Joo KH et al (2018) Point-of-care ultrasound-guided percutaneous cannulation of extracorporeal membrane oxygenation: make it simple. J Emerg Med 54(4):507–513 CrossRefPubMed

73.

Beck L, Burg MC, Heindel W, Schülke C (2017) Extracorporeal membrane oxygenation in adults – variants, complications during therapy, and the role of radiological imaging. Rofo 189(2):119–127 PubMed

74.

Pang PY, Wee GH, Hoo AE et al (2016) Therapeutic hypothermia in adult patients receiving extracorporeal life support: early results of a randomized controlled study. J Cardiothorac Surg 11:43 CrossRefPubMedPubMedCentral

75.

Spartera M, Jabbour RJ, Chiarito M, De Bonis M, Pappalardo F (2017) Stepwise use of circulatory support devices in a patient refractory to cardiopulmonary resuscitation. Cardiovasc Revasc Med 18(6):447–449 CrossRefPubMed

76.

Tepper S, Masood MF, Baltazar Garcia M et al (2017) Left ventricular unloading by Impella device versus surgical vent during extracorporeal life support. Ann Thorac Surg 104(3):861–867 CrossRefPubMed

77.

Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 39(2):119–177 (The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)) CrossRefPubMed

78.

Johnson B, Runyon M, Weekes A, Pearson D (2017) Team-focused cardiopulmonary resuscitation: prehospital principles adapted for emergency department cardiac arrest resuscitation. J Emerg Med. https://doi.org/10.1016/j.jemermed.2017.08.065 CrossRefPubMed

79.

Barbaro RP, Odetola FO, Kidwell KM et al (2015) Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med 191(8):894–901 CrossRefPubMedPubMedCentral

Titel: Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR)
Konsensuspapier der DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI und GRC
verfasst von: Prof. Dr. G. Michels
Dr. T. Wengenmayer
Prof. Dr. C. Hagl
Prof. Dr. C. Dohmen
Prof. Dr. B. W. Böttiger
Prof. Dr. J. Bauersachs
Prof. Dr. A. Markewitz
A. Bauer
Prof. Dr. J.-T. Gräsner
Prof. Dr. R. Pfister
Prof. Dr. A. Ghanem
Prof. Dr. H.-J. Busch
Prof. Dr. U. Kreimeier
Dr. A. Beckmann
Prof. Dr. M. Fischer
Prof. Dr. C. Kill
Prof. Dr. U. Janssens
Prof. Dr. S. Kluge
F. Born
Prof. Dr. H. M. Hoffmeister
PD Dr. M. Preusch
Prof. Dr. U. Boeken
Prof. Dr. R. Riessen
Prof. Dr. H. Thiele
Publikationsdatum: 02.07.2018
Verlag: Springer Medizin
Schlagwörter: Kardiogener Schock
Kardiopulmonale Reanimation
Kreislaufstillstand
Kardiogener Schock
ECMO
ECMO
Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin / Ausgabe 6/2018
Print ISSN: 2193-6218
Elektronische ISSN: 2193-6226
DOI: https://doi.org/10.1007/s00063-018-0452-8

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Springer Medizin

Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR)

Konsensuspapier der DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI und GRC

Zusammenfassung

Neu im Fachgebiet AINS

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Springer Medizin

Zusammenfassung

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