Ferrari Markus Wolfgang
Klinik Innere Medizin I, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Deutschland.
Herzschrittmacherther Elektrophysiol. 2016 Mar;27(1):25-30. doi: 10.1007/s00399-016-0421-y. Epub 2016 Feb 10.
Mechanical assist devices are indicated for hemodynamic stabilization in acute circulatory arrest if conventional means of cardiopulmonary resuscitation are unable to re-establish adequate organ perfusion. Their temporary use facilitates further diagnostic and therapeutic options in selected patients, e.g. coronary angiography followed by revascularization.External thorax compression devices allow sufficient cardiac massage in case of preclinical or in-hospital circulatory arrest, especially under complex transfer conditions. These devices perform standardized thorax compressions at a rate of 80-100 per minute. Invasive mechanical support devices are used in the catheter laboratory or in the intensive care unit. Axial turbine pumps, e.g. the Impella, continuously pump blood from the left ventricle into the aortic root. The Impella can also provide right ventricle support by pumping blood from the vena cava into the pulmonary artery. So-called emergency systems or ECMO devices consist of a centrifugal pump and a membrane oxygenator allowing complete takeover of cardiac and pulmonary functions. Withdrawing blood from the right atrium and vena cava, oxygenated blood is returned to the abdominal aorta. Isolated centrifugal pumps provide left heart support without an oxygenator after transseptal insertion of a venous cannula into the left atrium.Mechanical assist devices are indicated for acute organ protection and hemodynamic stabilization for diagnostic and therapeutic measures as well as bridge to myocardial recovery. Future technical developments and better insights into the pathophysiology of mechanical circulatory support will broaden the spectrum of indications of such devices in acute circulatory arrest.
如果传统的心肺复苏方法无法重新建立足够的器官灌注，机械辅助装置可用于急性循环骤停时的血流动力学稳定。在选定的患者中，其临时使用有助于进一步的诊断和治疗选择，例如冠状动脉造影后进行血运重建。外部胸部按压装置可在临床前或院内循环骤停时进行充分的心脏按摩，特别是在复杂的转运条件下。这些装置以每分钟80 - 100次的速率进行标准化的胸部按压。侵入性机械支持装置用于导管室或重症监护病房。轴向涡轮泵，例如Impella，持续将血液从左心室泵入主动脉根部。Impella还可通过将血液从腔静脉泵入肺动脉来提供右心室支持。所谓的紧急系统或体外膜肺氧合（ECMO）装置由离心泵和膜式氧合器组成，可完全替代心脏和肺部功能。从右心房和腔静脉抽取血液，含氧血液返回腹主动脉。在将静脉插管经房间隔插入左心房后，单独的离心泵可在无氧合器的情况下提供左心支持。机械辅助装置适用于急性器官保护和血流动力学稳定，以进行诊断和治疗措施以及作为心肌恢复的桥梁。未来的技术发展以及对机械循环支持病理生理学的更深入了解将拓宽此类装置在急性循环骤停中的适应证范围。
