Mechanische Kreislaufunterstützung im Schock

Zusammenfassung

Mechanische Kreislaufunterstützungssysteme (engl. Mechanical Circulatory Support, MCS) haben in den letzten Jahren eine zunehmende Bedeutung in der akutmedizinischen Therapie des kritisch kranken Patienten im Schock erlangt. Aktuell stehen in Europa verschiede Systeme zur Verfügung, die sich in Wirkweise und Einsatzgebiet signifikant unterscheiden. Neben den MCS-Charakteristika und der Zentrumsexpertise sind aber auch Patientencharakteristika für die Auswahl des richtigen MCS zu beachten. Unterschiedliche Schockformen fordern eine differenzierte Therapie, je nach Ätiologie des Schocks und seiner hämodynamischen Akzentuierung (so braucht z. B. ein infarktbedingter kardiogener Schock mit führendem Linksherzversagen eine andere Therapie als ein infarktbedingter kardiogener Schock mit führendem Rechtsherzversagen). Die Auswahl des jeweiligen Herzunterstützungssystems richtet sich nach der Pathophysiologie der zugrunde liegenden Erkrankung. Bisweilen sind Kombinationen von mehreren Unterstützungssystemen erforderlich. Dieser Übersichtsartikel diskutiert die verschiedenen Systeme (extrakorporale Membranoxygenierung, intraaortale Ballonpumpe, Mikroaxillarpumpe/perkutanes linksventrikuläres Unterstützungssystem, perkutanes rechtsventrikuläres Unterstützungssystem) und deren Einsatzmöglichkeit im Kontext der verschiedenen Schockformen.

Abstract

In recent years, mechanical circulatory support (MCS) systems have become increasingly important in the acute medical treatment of critically ill patients in shock. Currently, various systems are available in Europe, which differ significantly in their mode of action and field of application. In addition to MCS characteristics and center expertise, patient characteristics must also be taken into account when selecting the right MCS. Different types of shock require differentiated therapy, depending on the etiology of the shock and its hemodynamic accentuation (e.g., infarct-related cardiogenic shock with leading left heart failure requires different therapy than infarct-related cardiogenic shock with leading right heart failure). The selection of the particular cardiac support system depends on the pathophysiology of the underlying disease. At times, combinations of multiple support systems are required. This review article discusses the different systems (extracorporeal membrane oxygenation, intraaortic balloon pump, microaxillary pump/percutaneous left ventricular support system, percutaneous right ventricular support system) and their potential use in the context of the different types of shock.

Was ist wichtig?

• Zur kurzfristigen Kreislaufunterstützung sind die venoarterielle ECMO, TandemHeart, Impella und die intraaortale Ballonpumpe verfügbar, wobei letztere nach negativen randomisierten Studien in den Hintergrund tritt.

• Die VA-ECMO bietet als einziges System einen kompletten kardialen Shunt. Sowohl TandemHeart als auch Impella haben ihren Ansaugpunkt im linken Herzen.

• Aufgrund der Nachlasterhöhung durch VA-ECMO-Therapie sollte frühzeitig an die Entlastung des linken Ventrikels (z. B. mittels Impella) gedacht werden.

Schlüsselwörter

mechanische Kreislaufunterstüzung - Schock - ECMO - Mikroaxillarpumpe - perkutanes linksventrikuläres Unterstützungssystem - perkutanes rechtsventrikuläres Unterstützungssystem

Keywords

mechanical circulatory support - shock - microaxial support pump - percutaneous right ventricular assist device - percutaneous left ventricular assist device - ECMO

Publication History

Article published online:
13 October 2023

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