14a.heart Lung Machine

Heart Lung Machine
A heart-lung machine (Figure 89-10) is an apparatus that does the work both of the heart
(i.e., pumps blood) and the lungs (i.e., oxygenates the blood) during, for example, open-heart
surgery. The basic function of the machine is to oxygenate the body's venous supply of blood
and then to pump it back into the arterial system.
Blood returning to the heart is diverted through the machine before returning it to the
arterial circulation. Some of the more important components of these machinesinclude pumps,
oxygenators, temperature regulators, and filters. The heart-lung machine also provides
intracardiac suction, filtration, and temperature control.
During open heart surgery, the surgical intervention is typically performed on a
non-beating heart, and hence requires establishment of extracorporal circulation (ECC). During
ECC, a heart-lung-machine temporarily replaces the functionality of the heart and lungs. This
technique is therefore also called cardio pulmonary bypass (CPB).
During closed heart surgery, the incision is performed without use of a
heart-lung-machine. Coronary bypass operations can therefore in a number of cases be
performed on a beating heart without use of ECC. The method is called OPCAP (Off Pump
Coronary Artery Bypass).
During ECC the blood from the right side of the heart is drained through a venous
catheter to a venous reservoir. Following this, the blood is pumped to an artificial lung – the
oxygenator – where oxygen is added and carbondioxide is washed out. Finally the blood is
pumped back into the systemic circulation by an arterial canulla in aorta ascendens. The
oxygenator has a built-in heat-exchange system, which gives the blood the desired temperature.
1. Roller Pump:
The pump comfort frequently consists of numerous revolving motor pumps that
peristaltically ‘massage’ tubing. Pumping action occurs because the rollers on the rotating arm
comprises the tubings carrying the blood and forces the blood ahead of the compressed section.
This action is called peristaltic action and this leads to a pulsatile flow of blood through the
tubings. The heart-lung machine uses five pump heads normally.
In some cases we use centrifugal pumps for the safeguarding and control of blood flow
during the surgical procedure. By changing the RPM of pump head, blood flow is maintained.
This kind of pumping action is measured to be better to the action of roller pumps because it
produces less damage to the blood.
2. Oxygenator:
The oxygenator is planned to move oxygen to the infused blood and take away carbon
dioxide from venous blood. So simply the oxygenator assembly allows to oxygenate the blood.
Bubble oxygenators, membrane oxygenators and heparin coated blood oxygenators are the
different types of oxygenators. Of them, heparin coated blood oxygenators are the commonly
used one as they prevent blood coating.
3. Heat Exchanger:
Heat exchangers permit body and organ temperatures to be attuned. The uncomplicated
heat exchange design is a container of water. As the blood transfers through the tubing
positioned in the bath, the blood temperature will alter. A more complex system separated the
blood and water interface with a metallic barrier. As the water temperature is changed, the
blood temperature also changes, which in turn changes the tissue temperature. Once the tissue
temperature reaches the desired level, the water temperature is maintained.
Heat exchangers can be of two types namely plate type and coil type. In plate type of
heat exchangers, two sheets of metals are used and they are coated with a non – thrombogenic
substance. This configuration offers good efficient transfer of heat. Coil configuration consists of
a hollow coil through which water circulates. The disadvantage of this type is it is a non
disposable unit and is very difficult to clean.
4. Temperature Controller:
During the time the patient uses a heart-lung machine, body temperature is to be
maintained at a normal range. This unit allows the pump operator to keep the blood at a proper
temperature.
5. Blood and Oxygen Dispersion Plates:
In a heart – lung machine, the gas bubbles are dispersed into the venous blood in the
bubble column and acts as vehicles for both oxygen and carbon dioxide. Here oxygen diffuses
from the bubble into the blood film surrounding the bubble. Various types of dispersion plates
are used.
6. Reservoir:
A reservoir gather blood drained from the venous flow. Reservoir arranges include open
or closed systems. The open system displays demarcations corresponding to blood volume in
the container. The design is open to environment permitting blood to cross with environmental
gases. The closed system contains a bag and it eliminates the air-blood interface. Volume is
measured by weight or change in radius of the container.
7. Nylon Mesh Filters:
The nylon mesh filters used in heart-lung machines are attuned with a broad choice of
solvents. They are particularly used for gathering of algae and cells, atom analysis, big
particulate filtration, prefiltration of solvents and so on.
8. Cannulae:
Numerous cannulae are sewn into the suffering patient’s body in a diversity of position
depending on the kind of surgery. A venous cannula takes away the oxygen destitute blood
from the patient’s body and an arterial cannula is sewn into the suffering patient’s body to
impart oxygen rich blood. The cannula utilized to return oxygenated blood is frequently
inserted in the rising aorta.

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Heart Lung Machine

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