Download - Heart Lung Machine Pump
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HEART LUNG MACHINE
PUMP
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What is It ?
A medical equipment that providesCardiopulmonary bypass, (temporary
mechanical circulatory support) to the
stationary heart and lungs)
Heart and Lungs are made “functionless
temporarily” , in order to perform surgeries CABG
Valve repair Aneurysm
Septal Defects
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History
Lewis and Taufic first used the HypothermiaApproach clinically on September 2, 1952.
Under moderate total body hypothermia,
Lewis and Taufic used a short period of
circulatory arrest to repair a congenital defectin a 5 year-old girl.
An alternative approach named Cross-
Circulation was used by Dr. C. Walt whenon March 26, 1954,when he repaired a VSD
in a 12 month-old infant.
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On May 6, 1953, Dr. Gibbon used his heart –
lung machine to successfully repair an atrial
septal defect in an 18 year-old girl,
Marking the first successful clinical use of a
Heart –Lung Machine
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Modified – Mayo Clinic (1955)
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Present Day Machine
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Principles and Necessity
Heart is Stopped
Blood diverted through
tubes and is pumped
to maintain flow
Temperature regulation of blood
and gaseous exchange is done
Blood circulated systemicallybypassing the heart
and lungs
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Cardioplegia
The intentional and temporary cessation of cardiac
activity.
Common procedure for accomplishing asystole is
infusing cold crystalloid cardioplegia into thecoronary circulation. Iced (4 degrees Celsius)
solution of dextrose, potassium chloride, and
Magnesium rich solution is introduced via
specialized Cannula. B05XA16
MeSH
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Parts
Five pump assemblies Venous Cannula
Arterial Cannula - dual-stream aortic perfusion
catheter / meshed cannula
Venous Reservoir
Oxygenators
Heat Exchangers
Cardiotomy Reservoir and Field Suction Filters and Bubble Traps
Tubing and Connectors
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Pumps
Centrifugal pumps consist of plastic cones,which when rotated rapidly, propel blood bycentrifugal force.
Forward blood flow, varies with the speed of rotation and the after load of the arterial line.
Centrifugal blood pumps generate up to 900mm Hg of forward pressure, but only 400 to500 mm Hg of negative pressure. Hence,less gaseous micro emboli.
Centrifugal pumps produce pulse less blood
flow
Centrifugal
Roller
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Roller pumps consist tubing, which is
compressed by two rollers 180° apart.
Forward flow is generated by roller
compression and flow rate depends upon thediameter of the tubing, rate of rotation.
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Impeller PumpRoller Pump Centrifugal Pump
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Five pump assemblies :
A centrifugal or roller head pump can be used in the
arterial position for extracorporeal circulation of the
blood.
Left ventricular blood return is accomplished byroller pump, drawing blood away from the heart.
Surgical suction created by the roller pump removes
accumulated fluid from the general surgical field.
The cardioplegia delivery pump. Emergency Backup of the arterial pump in case of
mechanical failure.
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Venous Reservoirs
Reservoirs may be rigid (hard) plastic canisters
("open" types) or soft, collapsible plastic bags
("closed" types).
The venous reservoir serves as volume reservoir Facilitates gravity drainage,
Venous bubble trap present,
Provides a convenient place to add drugs, fluids, or
blood, and adds storage capacity for the perfusionsystem.
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Oxygenators
Membranous
Bubble
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Membranous Oxygenators
Imitate the natural lung by interspersing a thinmembrane of either micro porouspolypropylene or silicone rubber between thegas and blood phases.
With micro porous membranes, plasma-filledpores prevent gas entering blood but facilitatetransfer of both oxygen and CO2.
The most popular design uses sheaves of hollow fibers connected to inlet and outletmanifolds within a hard-shell jacket.
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Bubble Oxygenators
Venous blood drains directly into a chamber into
which oxygen is infused through a diffusion plate
(sparger).
The sparger produces thousands of small(approximately 36 µm) oxygen bubbles within blood.
Gas exchange occurs across a thin film at the blood-
gas interface around each bubble
Produce more particulate and gaseous microemboliare more reactive to blood elements.
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Heat Exchangers
Control body temperature by heating or
cooling blood passing through the perfusion
circuit
Temperature differences within the body and
perfusion circuit are limited to 5°C to 10°C to
prevent bubble emboli
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Filters and Bubble Traps
In the circuit, micro emboli are monitored by
arterial line ultrasound or monitoring screen
filtration pressure.
Depth filters consist of porous foam, have alarge, wetted surface and remove micro
emboli by impaction and absorption
Screen filters are usually made of wovenpolyester or nylon thread.
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Tubing
Medical grade Polyvinyl Chloride (PVC) tubing
It is flexible, compatible with blood, inert,
nontoxic, smooth, nonwettable, tough,transparent, resistant to kinking and collapse,
Can be heat sterilized
The Duraflo II heparin coating ionicallyattaches heparin to a quaternary ammoniumcarrier (alkylbenzyl dimethyl - ammoniumchloride), which binds to plastic surfaces.
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Perfusion Monitors and Sensors
A low-level sensor with alarms on the venousreservoir and a bubble detector on the arterial
line are desirable safety devices.
Flow-through devices are available to
continuously measure blood gases,hemoglobin/hematocrit , and some electrolytes
Temperatures of the water entering heatexchangers
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Sterilization :
Ethylene dioxide is commonly used
4 hours of sterilization at 55°C or 18 hours at22°C .
Disadvantages of ethylene dioxide , are thetoxicity and explosive nature
Disposable tubing ,reservoirs and oxgenator Steam sterilization as PVC can withstand
heat
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Disadvantages
Post perfusion Syndrome - a transient
neurocognitive impairment associated with
cardiopulmonary bypass. Some research
shows the incidence is initially decreased byoff-pump coronary artery bypass
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Off Pump CABG
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The Future !!
CARDIOARM
Carnegie Mellon University
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References
Cohn LH, Edmunds LH Jr, - Cardiac Surgery in the Adult
Wiley - Encyclopedia of Medical Devices and Instrumentation - Vol. 3
Joseph Carr , Brown –
4 th edition Cardiopulmonary Bypass: Principles and
Practice, 2nd edition - Gravelee, Glenn P.,Richard F. Davis, Mark Kurusz, and Joe R. Utley
Sterilizing procedures for heart-lung machines - J. C. Kelsey