Artificial lung and heart set to save lives29/11/2018
For almost two hours she was clinically dead. Heart failure. All the resuscitation attempts of Angehömembered and Sanitätern – unsuccessful. Even Stromstöße do not put your heart in gear. There’s a Ä met;rzteteam to the Universitäclinic Freiburg an immediate decision: The physicians closed their 44-jäyears patient a novel Gerät that replaces the heart and lungs. They extended, moreover, a closed Herzkranzgefäß – and soon, the heartbeat started again.
And not only that: Säall bodies recovered, including the brain, which reacts to oxygen deficiency, are particularly sensitive. Only the Rücover mark took ötender is a partial Beinlä damage, ;hmung remained zurück. Today, the patient works full time can at least go 30 steps and a annäbasically normal life führen.
The case of Freiburg is a medical miracle. In this Auspräthe settlement hardly ever &ndash occurs; so far, at least. Ädoctors and cardiac technicians want the ächange. Increasingly häsingle-stage set in patients with cardiac arrest, a kü stand;artificial heart set a, äsimilar to a heart-lung machine in the operating room. This so-called extracorporeal Life Support System (ECLS) unterstüsupports the Köthe body until the organs resume their function.
Less Hirnschäthe more advanced model
Already in the year 2014, approximately 3,000 people in Germany were treated in this way, a strong upward trend. Dr. Dirk Buchwald, senior cardiovascular technician of the clinic für cardiac and thoracic surgery at the University hospital Bergmannsheil in Bochum, zäat the hlt examples of use in: patients in whom the heart after a heart attack, too weak schlägt; if the Pumporgan failed after a OP; if the circuit due to a Unterkümisconduct exposes.
In Freiburg is currently being tested already in a more advanced model. The Motivation behind it: Just about every füfifth Patient üa resuscitation in a hospital berlebt in the long term; außoutside of Krankenhäusers the ratio is even worse. Who creates it, behält häfrequently more or less severe Hirnschäthe zurück. This is not only the lack of oxygen, if the heart pressure massage verzögert uses. In addition, Schä arise;the, of all things, then, if oxygen in the underserved area of zurückkehrt. This has a negative impact für the heart muscle, für the thinking organ, and für the long-term Üsurvival. Ädoctors and engineers have the innovative ECLS-Gerät therefore, so ausgerüstet that the Gewebeschäthe slimming.
For example, this is achieved by Adjusting the temperature and blood pressure. Up to ten parameters can be individually abächange, also drugs köcan be added to. 13 patients had been treated with the optimized ECLS, 6 of them häsites without Hirnschäending überlebt, reported Professor Friedhelm Beyersdorf. By the end of 2018, hopes the ämedical Director of the Freiburg clinic für heart and Gefäßsurgery, comes the Gerät on the market. "We köcan not sure all of the patients vöcompletely healthy machen", so the heart surgeon. "I wäre already happy if more of them without neurological Schäthe üsurvival köcould."
The Problem is that Not all patients benefit from the heart rate
Some clinics do not wait until the Patient arrives. Use the ECLS already in Rettungseinsäsupport. For example, a Team of specialists at the University hospital Regensburg. "We are twice to three times as successful as in the case of üblicher heart-lung Wiederbelebung", says Dr. Dirk Lunz, head of the emergency transport. 25 to 30 percent of patients üsurvival.
Despite all the success messages – a Dilemma remains: Who is really the machine Unterstüup of benefits, know the Ädoctors only in retrospect. Maybe üthe Patient berlebt, is hindered but hard mentally. Who the Gerä to;te use? Dafür so far, there are only points of reference. Surgeon Beyer village about rät of a machine’s Intervention, if it is not known how long an untreated cardiac arrest zurü stand;ckliegt. Because then the brain is usually irreparable geschädamaged. Zusäin addition to play in the decision of the physician the age of the patient, as well as the pre-existing conditions a role.
The replacement for lung or heart function
Lung Unterstüsetting up the system (ECMO)
The lung provides the Köthe body is no longer sufficient to grab Ädoctors to a technical Unterstüsetting up the system. It is the blood of the iliac vein with oxygen (O2) enriched and removes carbon dioxide (CO2). The oxygen-rich blood, usually üabout the jugular vein in the neck, in the Köbody zurückgeleitet.
Heart-Lung Unterstüsetting up the system (ECLS)
Pump replacing the heart too weak or not at all, the same Gerät both bodies. The blood is derived from the iliac vein and enriched with oxygen. Unlike the pure Lungenunterstüup it is however in the iliac artery zurückgeleitet. Üabout the veins-arteries-connection uses the pump of the Unterstüup system the circulation going again.
ECMO: the help if the lung is not working
Generally speaking, less Gehirnschäthe face if the heart schlägt, but the lungs are not sufficiently working. Even Ä use;doctors technical assistance – the extracorporeal Membrane oxygenation (ECMO). Just under 2000 Times, this type of Lungenunterstü was;up 2014 used, as a Professor of Christian what the authorities on the basis of the diagnostic data of the German Krankenhäuser determined. What the authorities has been künewly appointed Professor für extracorporeal lung replacement procedure of the Universität Witten/Herdecke appointed, the first and only of its kind in Germany.
A strong push was the method of the Influenzawave in the Winter of 2009/10. The so-called swine flu called at that time a number of young, previously healthy people with a severe Lungenentzümaking, the schließin an acute lung mü failure;friends. Plöin addition, the ECMO centres were in great demand. A machine your lungs replaced, and your blood treated, saved many Affected life.
Especially in Germany, many smaller hospitals have since the Gerät purchased – use it but only rarely. "With from time to time it works but nicht", erklärt expert what the authorities. "In clinics with großhe’s ECMO experience üsurvival of 50 to 60 percent of the Treated. In Germany, this Rate was found to be in 2016, only 42 percent of the average of all German hospitals."
Bleeding in the brain due to lung replacement
Better köcould be the balance in his opinion, wüthe patients would be in größEUA centres transported. There are usually specially trained and experienced Teams. Because the Geräte are now compact and easy köthese specialists if necessary, can also velvet Zubehör in other Krankenhäuser open. There schließto move the patient to the lung machine and beföpromote him in his own clinic.
However, in the case of ECMO &ndash turns; as with the ECLS – the question: to Whom nüone such effort supported? In a still unveröpublished guideline have agreed to experts, the Geräte is only used when all other options fail, or there is a medical Grünot kö be applied;can. Für the Zurückhaltung there is a reason for that: ECMO has Tücover. So zerstört the pump Blutpläleaves, außerdem is activated and consumes the contact with köbody foreign Material coagulation factors. Bleeding, therefore, the hämost common complication. According to an international database of four percent of the Treated suffer a brain hemorrhage.
Gain time, so that the Köthe body can heal
"We köcan with of this therapy does not heal, we köcan only time gewinnen", Dr. Thomas Mü also stresses;ller, head of the ICU of the University hospital of Regensburg. With the disease causing the respiratory failure, müshot medication and the Köthe body of the patient. In the case of a severe Lungenentzümaking about unterstüsupports the Gerät is the breathing for so long until antibiotics, the pathogen zerstört, the lung has recovered.
Respiratory failure caused by severe diseases, is the most important area of application of ECMO. Is used it also in the case of lung injury due to Unfälle. "These patients often have the best prognosis, because they häoften before vöcompletely healthy waren", what the authorities says. Außerdem can ECMO the Intensität a küartificial respiration to reduce. This is important because too much pressure on the lungs suffers, it cycle can give problems, some patients die because the right ventricle joins. "Thanks to ECMO can the pressure go down and the breathing much gentler gestalten", erklärt Müller.
Für many other möpossible use of the current data situation, however, dünn. For example, in which Fäcases, patients with the chronic lung disease COPD by the method of benefit. However, despite all the questions fü is;r Thomas Müall clear: "The mechanical heart – and Lungenunterstüup in the last few years, the main innovation of the intensive care medicine."