Pumpless extracorporeal membrane oxygenation

from Wikipedia, the free encyclopedia

In emergency and intensive care medicine , pumpless extracorporeal membrane oxygenation or pumpless extracorporeal lung support ( pECLA ) is a technique that can be used to remove carbon dioxide from the blood and supply oxygen in patients with acute lung failure while avoiding the risks of the known pump processes. Two large-lumen cannulas are inserted into an artery and a vein , e.g. B. the femoral artery and the femoral vein or external jugular vein introduced. The blood flows through a relatively short tube along the pressure gradient through a so-called oxygenator , which is gassed with an oxygen-nitrogen mixture. In everyday clinical practice, dosing is carried out using a variable area flow meter . The system is supplemented by a contactless blood flow meter.

Corresponding to the way the pECLA works, the procedure is dependent on sufficient or even excessive cardiac output . With pumpless lung support, the extracorporeal flow depends directly on the pressure difference between the arterial and venous systems generated by the heart. If the extracorporeal flow is too low, not enough oxygen can sometimes be brought into the body or not enough carbon dioxide can be removed from the bloodstream. In such cases, the last option for lung replacement therapy is extracorporeal membrane oxygenation .

The pECLA is a very new procedure which is of growing importance as an adjuvant measure in the therapy of acute, reversible lung failure, e.g. B. after trauma , pancreatitis , severe pneumonia , sepsis and ARDS .

See also

Individual evidence

  1. ^ R. Kopp, R. Bensberg, M. Wardeh, R. Rossaint, R. Kuhlen, D. Henzler: Pumpless arterio-venous extracorporeal lung assist compared with veno-venous extracorporeal membrane oxygenation during experimental lung injury. In: British journal of anesthesia. Volume 108, Number 5, May 2012, pp. 745-753, ISSN  1471-6771 . doi : 10.1093 / bja / aes021 . PMID 22374939 .
  2. ^ A. Liebold, A. Philipp, M. Kaiser, J. Merk, FX Schmid, DE Birnbaum: Pumpless extracorporeal lung assist using an arterio-venous shunt. Applications and limitations. In: Minerva anestesiologica. Volume 68, Number 5, May 2002, pp. 387-391, ISSN  0375-9393 . PMID 12029251 .
  3. ^ T. Bein, C. Prasser, A. Philipp, T. Müller, F. Weber, HJ Schlitt, FX Schmid, K. Taeger, D. Birnbaum: [Pumpless extracorporeal lung assist using arterio-venous shunt in severe ARDS. Experience with 30 cases]. In: The anesthesiologist. Volume 53, Number 9, September 2004, pp. 813-819, ISSN  0003-2417 . doi : 10.1007 / s00101-004-0699-8 . PMID 15221117 .