HEART-LUNG
MACHINE
By :- Prajwal Chauhan (303040)
Cardiopulmonary bypass (CPB) is a
technique that temporarily takes over the
function of the heart and lungs during
surgery, maintaining the circulation of blood
and the oxygen content of the patient's body.
INTRODUCTION
The CPB pump itself is often referred to as a
heart–lung machine or "the pump".
Cardiopulmonary bypass pumps are operated
by perfusionists. CPB is a form of
extracorporeal circulation.
Cardiopulmonary bypass is commonly used in
coronary bypass heart surgery because of the
difficulty of operating on the beating heart.
CPB can be used for the induction of total body
hypothermia.
USES
Extracorporeal membrane oxygenation (ECMO)
is a form of CPB sometimes used as life-support
for newborns with serious birth defects, or to
oxygenate and maintain recipients for organ
transplantation until new organs can be found.
SURGICAL PROCEDURES IN WHICH CPB IS
USED:
Coronary artery bypass surgery
Cardiac valve repair and/or replacement (aortic valve, mitral valve, tricuspid valve,
pulmonic valve)
Repair of large septal defects (atrial septal defect, ventricular septal defect,
atrioventricular septal defect)
Repair and/or palliation of congenital heart defects (Tetralogy of Fallot, transposition
of the great vessels)
Transplantation (heart transplantation, lung transplantation, heart–lung transplantation)
Repair of some large aneurysms (aortic aneurysms, cerebral aneurysms)
Pulmonary thromboendarterectomy
Pulmonary thrombectomy
CPB mechanically circulates and oxygenates blood for
the body while bypassing the heart and lungs. It uses a
heart–lung machine to maintain perfusion to other body
organs and tissues while the surgeon works in a
bloodless surgical field.
The surgeon places a cannula in right atrium, vena
cava, or femoral vein to withdraw blood from the body.
The cannula is connected to tubing filled with isotonic
crystalloid solution.
Venous blood that is removed from the body by the
cannula is filtered, cooled or warmed, oxygenated, and
WORKING then returned to the body. The cannula used to return
oxygenated blood is usually inserted in the ascending
aorta, but it may be inserted in the femoral artery.
The patient is administered heparin to prevent
clotting, and protamine sulfate is given after to
reverse effects of heparin. During the procedure,
hypothermia may be maintained; body temperature is
usually kept at 28 °C to 32 °C (82.4–89.6 °F). The blood
is cooled during CPB and returned to the body. The
cooled blood slows the body's basal metabolic rate,
decreasing its demand for oxygen. Cooled blood usually
has a higher viscosity, but the crystalloid solution used
to prime the bypass tubing dilutes the blood.
Oxygenato
Tubing Pump Cannulae
r
COMPONENTS
TUBING
The components of the CPB circuit are interconnected by a series of tubes made
of silicone rubber or PVC.
PUMP
Roller pump
The pump console usually comprises several rotating
motor-driven pumps that peristaltically "massage"
tubing. This action gently propels the blood through the
tubing. This is commonly referred to as a roller pump, or
peristaltic pump.
Centrifugal pump
Many CPB circuits now employ a centrifugal pump for the
maintenance and control of blood flow during CPB. By
altering the speed of revolution (RPM) of the pump head,
blood flow is produced by centrifugal force.
OXYGENATOR
The oxygenator is designed to add
oxygen to infused blood and remove
some of the carbon dioxide from the
venous blood. Cardiac surgery was
made possible by CPB using bubble
oxygenators, but membrane
oxygenators have supplanted bubble
oxygenators since the 1980s.
Another type of oxygenator gaining
favour recently is the heparincoated
blood oxygenator which is believed
to produce less systemic
inflammation and decrease the
propensity for blood to clot in the
CPB circuit.
CANNULA
A venous cannula removes
oxygen depleted venous blood
from a patient's body.
An arterial cannula infuses
oxygen-rich blood into the arterial
system.
A cardioplegia cannula delivers a
cardioplegia solution to cause the
heart to stop beating.
LIMITATIONS TO CPB:
CPB is not benign and there are a number of associated problems:
Postperfusion syndrome (also known as "pumphead")
Hemolysis Capillary leak syndrome
Clotting of blood in the circuit – can block the circuit (particularly the
oxygenator) or send a clot into the patient.
Air embolism Leakage – a patient can rapidly exsanguinate (lose blood
perfusion of tissues) if a line becomes disconnected.
1.5% of patients that undergo CPB are at risk of developing Acute
Respiratory Distress Syndrome.
