Supady Alexander, Michels Guido, Lepper Philipp M, Ferrari Markus, Wippermann Jens, Sabashnikov Anton, Thiele Holger, Hennersdorf Marcus, Lahmer Tobias, Boeken Udo, Gummert Jan, Tigges Eike, Muellenbach Ralf M, Spangenberg Tobias, Wengenmayer Tobias, Staudacher Dawid L
Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
Abteilung für Kardiologie und Angiologie I, Universitäts Herzzentrum Freiburg Bad Krozingen, Universität Freiburg, Freiburg, Deutschland.
Med Klin Intensivmed Notfmed. 2023 Sep;118(6):492-498. doi: 10.1007/s00063-022-00951-3. Epub 2022 Sep 8.
At the onset of the coronavirus pandemic, concerns were raised about sufficiency of available intensive care resources. In many places, routine interventions were postponed and criteria for the allocation of scarce resources were formulated. In Germany, some hospitals were at times seriously burdened during the course of the pandemic. Intensive care units in particular experienced a shortage of resources, which may have led to a restriction of services and a stricter indication setting for resource-intensive measures such as extracorporeal membrane oxygenation (ECMO). The aim of this work is to provide an overview of how these pressures were managed at large ECMO centers in Germany.
One representative of each major ECMO referral center in Germany was invited to participate in an online survey in spring 2021.
Of 34 invitations that were sent out, the survey was answered by 23 participants. In all centers, routine procedures were postponed during the pandemic. Half of the centers increased the number of beds on which ECMO procedures could be offered. Nevertheless, in one-third of the centers, the start of at least one ECMO support was delayed because of a feared resource shortage. In 17% of centers, at least one patient was denied ECMO that he or she would have most likely received under prepandemic conditions.
The results of this online survey indicate that the experienced pressures and resource constraints led some centers to be cautious about ECMO indications.
在冠状病毒大流行开始时，人们对可用重症监护资源的充足性表示担忧。在许多地方，常规干预措施被推迟，并制定了稀缺资源分配标准。在德国，一些医院在疫情期间有时负担沉重。特别是重症监护病房资源短缺，这可能导致服务受限，以及对体外膜肺氧合（ECMO）等资源密集型措施设置更严格的适应症标准。这项工作的目的是概述德国大型ECMO中心是如何应对这些压力的。
2021年春季，邀请了德国每个主要ECMO转诊中心的一名代表参加在线调查。
在发出的34份邀请中，有23名参与者回复了调查。在所有中心，疫情期间常规程序都被推迟。一半的中心增加了可进行ECMO程序的床位数量。然而，三分之一的中心由于担心资源短缺，至少有一次ECMO支持的启动被推迟。在17%的中心，至少有一名患者被拒绝使用ECMO，而在疫情前的情况下他或她很可能会接受该治疗。
这项在线调查的结果表明，所经历的压力和资源限制导致一些中心对ECMO适应症持谨慎态度。
