Mechanische Kreislaufunterstützungssysteme im kardiogenen Schock

Abstract

Cardiogenic shock represents a situation with inadequate tissue perfusion resulting from cardiac dysfunction, mostly caused by myocardial infarction. The mortality rate persists on a high level and can be decreased by acute revascularization. In cases with persisting shock despite optimal medical therapy including balanced catecholamine/ volume-therapy and development of a multiorgandysfunction-syndrome (MODS), the use of extracorporal assist devices may lead to a stabilization of the hemodynamic state. The implantation of an intraaortic balloon counterpulsation is not more recommended, since the IABP-Shock-II trial has been published. Actually, there are three possibilities of percutaneous assist systems: TandemHeart, Impella-Recover and extracorporal membrane oxygenation (ECMO). All of these systems lead to a hemodynamic improvement. However, a reduction of the mortality rate has only been shown in small trials. Parameters of better outcome following ECLS-therapy are the initial pH and lactate-concentration, the duration of CPR before implantation and the development of a MODS, as well as the rate of device-related complications. Randomized trials are needed to corroborate the benefit of the use of these systems.

• Literatur

• 1 Thiele H. Treatment of cardiogenic shock: What is proven?. Dtsch Med Wschr 2013; 138: 1960-1965
• 2 Naidu SS. Novel Percutaneous Cardiac Assist Devices. The Science of and Indications for Hemodynamic Support. . Circulation 2011; 123: 533-543
• 3 Ouweneel DM, Henriques JPS. Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations. Heart 2012; 98: 1246-1254
• 4 Sjauw KD, Engstrom AE, Vis MM et al. A systematic review and meta-analysis of intra aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?. Eur Heart J 2009; 30: 459-468
• 5 Thiele H, Zeymer U, Neumann FJ et al. IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: 1287-1296
• 6 Thiele H, Zeymer U, Neumann FJ et al. on behalf of the Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators† Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382: 1638-1645
• 7 Burkhoff D, Cohen H, Brunckhorst C et al. for the TandemHeart Investigators Group. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. . Am Heart J 2006; 152: 469
• 8 Cheng JM, den UilCA, Hoeks SA et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J 2009; 30: 2102-2108
• 9 O’Neill WW, Schreiber T, Wohns DHW et al. The Current Use of Impella 2.5 in Acute Myocardial Infarction Complicated by Cardiogenic Shock: Results from the USpella Registry. J Interven Cardiol 2014; 27: 1-11
• 10 Lauten A, Engström AE, Jung C et al. Percutaneous Left-Ventricular Support With the Impella-2.5–Assist Device in Acute Cardiogenic Shock Results of the Impella–EUROSHOCK-Registry. . Circ Heart Fail 2013; 6: 23-30
• 11 Engstrom AE, Cocchieri R, Driessen AH et al. The Impella 2.5 and 5.0 devices for ST-elevation myocardial infarction patients presenting with severe and profound cardiogenic shock: The Academic Medical Center intensive care unit experience. . Crit Care Med 2011; 39: 2072-2079
• 12 Werdan K, Gielen S, Ebelt H et al. Mechanical circulatory support in cardiogenic shock. Eur Heart J 2014; 35: 156-167
• 13 Froesch P, Martinelli M, Meier P et al. Clinical use of temporary percutaneous left ventricular assist devices. Catherization Cardiovasc Interv 2011; 78: 304-313
• 14 Sheu JJ, Tsai TH, Lee FY et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med 2010; 38: 1810-1817
• 15 Demondion P, Fournel L, Golmard JL et al. Predictors of 30-day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support. Eur J Cardiothorac Surg 2014; 45: 47-54
• 16 Guenther S, Theiss HD, Fischer M et al. Percutaneous extracorporeal life support for patients in therapy refractory cardiogenic shock: initial results of an interdisciplinary team. Interact Cardiovasc Thorac Surg 2014; 18: 283-291
• 17 Haneya A, Philipp A, Diez C et al. A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest. Resuscitation 2012; 83: 1331-1337
• 18 Leick J, Liebetrau C, Szardien S et al. Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol 2013; 102: 661-669
• 19 Avalli L, Maggioni E, Formica F et al. Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: An Italian tertiary care centre experience. Resuscitation 2012; 83: 579-583
• 20 Cheng R, Hachamovitch R, Kittleson M et al. Complications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients. Ann Thorac Surg 2014; 97: 610-616
• 21 Lou S, Maclaren G, Best D et al. Hemolysis in Pediatric Patients Receiving Centrifugal-Pump Extracorporeal Membrane Oxygenation: Prevalence, Risk Factors, and Outcomes. Crit Care Med 2013; Epub ahead of print
• 22 Sakamoto S, Tanigushi N, Nakajima S et al. Extracorporeal Life Support for Cardiogenic Shock or Cardiac Arrest Due to Acute Coronary Syndrome. Ann Thor Surg 2012; 94: 1-7
• 23 Chang WW, Tsai FC, Tsai TY et al. Predictors of Mortality in Patients Successfully Weaned from Extracorporeal Membrane Oxygenation. PLoS One 2012; 7: e42687