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Prepared by:Makwana Hiren J. Shah Manthan M.
The Heart-lung machine is a device which is used to provide blood circulation and oxygenation while the heart is stopped during the open heart surgery. Heart-lung machine consists of three main functional units, the pump, the oxygenator and heat exchanger. To function, the heart-lung machine must be connected to the patient in a way that allows blood to be removed, processed, and returned to the body.
though this may be considered the beginning of research into a heart-lung device. but their problem was not to be solved. He repaired an atrial septal defect in an 18-year-old woman. The first successful open heart procedure on a human utilizing the heart lung machine was performed by John Gibbon in 1953. They filtered the blood through various screens and membranes and even pumped it through the lungs of dogs or monkeys.History The researchers searched mainly for a means to provide oxygenated blood to organ preparations. .
The heart-lung machine is valuable during this time since the patient is unable to maintain blood flow to the lungs or the body.Purpose of Heart-lung machine:The heart-lung machine provides the benefit of a motionless heart during open heart surgery. .
. heart–lung transplantation) Implantation of heart. Cardiac valve repair and/or replacement (aortic valve. tricuspid valve. lung transplantation. ventricular septum defect. mitral valve. atrioventricular septum defect) Transplantation (heart transplantation. pulmonic valve) Repair of large septum defects (atrial septum defect.Surgical procedures in which Heartlung machine is used:Coronary artery bypasses surgery.
Block diagram:- .
Components of Heart-lung Machine:Cardioplegia Cannula Blood reservoir Heparin Pump Roller pumps/Centrifugal pump Oxygenators Heat Exchanger .
.Cardioplegia Heart-lung machine circuit consists of a separate circuit for infusing a solution into the heart itself to produce cardioplegia to stop the heart from beating. and to provide myocardial protection (to prevent death of heart tissue).
A cardioplegia cannula is sewn into the heart to deliver a cardioplegia solution to cause the heart to stop beating . An arterial cannula is sewn into a patient's body and is used to infuse oxygen-rich blood.Cannula A venous cannula removes oxygen deprived blood from a patient's body.
. or blood. fluids.Blood reservoir The blood reservoir serves as a receiving chamber for venous return. provides a convenient place to add drugs. and adds storage capacity for the perfusion system. collapsible plastic bags. Reservoirs may be rigid (hard) plastic or soft. facilitates a venous bubble trap.
A powerful anticoagulant. Heparin should be given to the patient in order to reduce the blood's ability to clot. .Heparin Pump Once using a heart-lung machine during openheart surgery. reducing the risk of clots forming in the heart-lung machine.
Blood is then pushed ahead of the moving roller. Roller pumps Roller pumps compress a segment of the blood filled tubing. Roller pumps consist tubing. Excessive compression of the tubing in a roller pump increases the risk of hemolysis.Pumping system 1. which is compressed by two rollers 180° apart. . Forward flow is generated by roller compression and flow rate depends upon the diameter of the tubing. rate of rotation.
The compression of the rollers against the raceway is adjustable. (B) The impeller pump uses vanes mounted on a rotating central shaft. (A) Roller pumps with two rollers.Conti Fig: Diagrams of blood pumps. (C) The centrifugal pump uses three rapidly rotated. Blood is propelled in the direction of rotation. 180 degrees apart. concentric cones to propel blood forward by centrifugal force .
which when rotated rapidly. It consists of smooth plastic cones. An arterial flow meter is required to determine forward blood flow. propel blood by centrifugal force.2 Centrifugal pump Centrifugal pump have replaced roller pumps at many institutions. mainly because they cannot over pressurize the heart-lung machine system. . which varies with the speed of rotation and the after load of the arterial line.
Oxygenators Oxygenators not only supply vital oxygen for the blood. but also transport carbon dioxide. anaesthetics and other gases into and out of the circulation. There are three types of oxygenator 1. Membrane oxygenators 2. Film oxygenator . Bubble oxygenator 3.
. The hollow fiber bundles are potted at each end to separate the blood and gas compartments. Oxygen and carbon dioxide diffuse in opposite directions across the aggregate large surface of the hollow fibers. Oxygen enters one end of the bundles of hollow fibers and exits at the opposite end.Membrane oxygenators Membrane oxygenators imitate the natural lung by a thin membrane of either micro porous polypropylene or silicone rubber between the gas and blood phases. Diagram of a hollow fiber membrane oxygenator and heat exchanger unit.1.
The diffusion plate produces thousands of small oxygen bubbles within blood. venous blood drains directly into a chamber into which oxygen is infused through a diffusion plate. Gas exchange occurs across a thin film at the blood-gas interface around each bubble.Bubble oxygenator In bubble oxygenators.2. . Carbon dioxide diffuses into the bubble and oxygen diffuses outward into blood.
In heat exchanger. blood flows through spiralling coils made of stainless steel. The inner walls of the coils are coated with polymers to limit blood-surface interactions.Heat Exchanger Control body temperature by heating or cooling blood passing through the perfusion circuit. The circulating water is chilled to nearly 0 0C in an ice bath and heated by an electric resistance coil to an absolute maximum of 42 0C. .
. The surgeon gradually occludes the arterial pressure and pulse. and central venous pressure are monitored and adjusted. When cardiac performance is satisfactory and stable.Stopping of Heart-lung machine Once operation is completed. protamine is given to reverse cardioplegia and blood return from the surgical field is discontinued.
. 1.Complications Haemolysis Capillary leak syndrome Clotting of blood in the circuit – can block the circuit or send a clot into the patient.5% of patients that undergo Heart-lung machine are at risk of developing Acute Respiratory Distress Syndrome. Air embolism Leakage – lose blood perfusion of tissue if a line becomes disconnected.
Per fusionists take care of the connection procedures and maintain the performance of machine as per requirement at the time of surgeries. To overcome that Automation of Heart-Lung machine is a need. . During surgery. sometimes there occur faults due to carelessness.Why Automation in the Heart-lung Machine needed? During open heart surgery. Pressure in the arterial line is monitored continuously to instantly detect any increased resistance to arterial inflow into the patient.
Computerized CPB System The computerized CPB system consists of an 80286 microcomputer. . a collapse sensor. a reservoir blood level sensor. and temperature sensor.
In case the computer breaks down. . On detecting the improper sensor output. a perfusionist can take over the pump control by turning an automatic/manual switch to the manual mode. the computer maintains both the flow rates constant and displays a warning message with estimated locations of the trouble.Safety mechanisms The computer regularly verifies all samples with their prior values and detects not only artifacts but also hardware failures. The pump rotation speeds are also monitored and matched with the computer's command.