We thank PD Dr Muellenbach and coauthors for their additional comments, which once more emphasize one of the messages of our article.
It is beyond argument that the treatment of critically ill patients with severe pulmonary failure should be concentrated in centers because highly specialized management can further improve the chances of survival. Using extracorporeal pulmonary support is one of several therapeutic options in the context of the treatment and should, in our opinion, also be restricted to centers. In our article for Deutsches Ärzteblatt we tried to make that very point.
Potentially life-threatening complications need to be detected and managed as early as possible; this is possible only if staff are experienced and intensively trained, and if colleagues from other medical specialties are accessible, for example, vascular surgeons.
The main prerequisite for treating such patients in centers is a mobile ECMO team that can externally initiate extracorporeal support if required, in order to ensure safe transportation. PD Dr Hinkelbein and colleagues rightly emphasize that cannulating critically ill patients in external hospitals and their subsequent transportation on ECMO are not without risks. Smooth logistics, standardized procedures, and specialized teams are essential. The publication of our results and experiences with a total of 126 patients who were transported on venovenous ECMO is in preparation.
Extracorporeal procedures are used in neonates and children with respiratory or cardiac failure worldwide and in high volumes. The indication and the practical approach differ substantially from the treatment of adults. To explain this in greater detail would have exceeded the scope of our review article and was therefore explicitly not included.
Introducing quality assurance for the treatment of severe acute respiratory syndrome by using extracorporeal therapy, such as PD Dr Muellenbach mentioned, is well established in other countries and should be aimed for in Germany. A promising initiative is being prepared by the ARDS Network Germany, in order to establish therapeutic standards and thus further optimize the treatment of these seriously ill patients.
on behalf of the authors
PD Dr. med. Thomas Müller
Prof. Dr. med. Thomas Bein
Conflict of interest statement
PD Dr Müller has received reimbursement of travel expenses and lecture fees from Maquet Cardiopulmonary, Rastatt, Germany.
Prof. Bein has received fees for consultancy on the Advisory Board and lecture fees from Novalung, Heilbronn, Germany.
|1.||Müller T, Bein T, Philipp A, Graf B, Schmid C, Riegger G: Extracorporeal pulmonary support in severe pulmonary failure in adults—a treatment rediscovered. Dtsch Arztebl Int 2013; 110(10): 159–66 VOLLTEXT|