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Encyclopedia > Cardiopulmonary bypass
A Heart-Lung Machine (upper right) in a Coronary Artery Bypass surgery (CABG)
A Heart-Lung Machine (upper right) in a Coronary Artery Bypass surgery (CABG)

Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during surgery. It maintains the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a Heart-Lung Machine or the Pumper. Cardiopulmonary bypass pumps are operated by allied health professionals known as Perfusionists in association with surgeons who connect the pump to the patient's body. CPB is a form of extracorporeal circulation. Image File history File links Download high resolution version (6010x4586, 2218 KB) http://fmp. ... Image File history File links Download high resolution version (6010x4586, 2218 KB) http://fmp. ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... The heart and lungs, from an older edition of Grays Anatomy. ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ... The Allied health professions are those clinical health professions distinct from the medical profession and nursing profession. ... A perfusionist in front of a heart-lung machine (upper right) early in a coronary artery bypass surgery. ... An extracorporeal medical procedure is any medical procedure which is carried outside the body. ...

Contents

Uses of cardiopulmonary bypass

Cardiopulmonary bypass is commonly used in heart surgery because of the difficulty of operating on the beating heart. Operations requiring the opening of the chambers of the heart require the use of CPB to support the circulation during that period. Cardiac surgery is surgery on the heart, typically to correct congenital heart disease or the complications of ischaemic heart disease or valve problems caused by endocarditis. ... Diagram of the human circulatory system. ...


CPB can be used for the induction of total body hypothermia, a state in which the body can be maintained for an hour or more without perfusion (blood flow). If blood flow is stopped at normal body temperature, permanent brain damage normally occurs in three to four minutes — death may follow shortly afterward. Hypothermia refers to any condition in which the temperature of a body drops below the level required for normal metabolism and/or bodily function to take place. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ... Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when temperature surrounding is very different. ... Brain damage or brain injury is the destruction or degeneration of brain cells. ...


ECMO is a simplified 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. In intensive care medicine, extracorporeal membrane oxygenation (ECMO) is a technique of providing oxygen to patients whose lungs are so severely diseased that they can no longer serve their function. ... Life support, in the medical field, refers to a set of therapies for preserving a patients life when essential body systems are not functioning sufficiently to sustain life unaided. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Oxygenated substances have been infused with oxygen. ... An organ transplant is the transplantation of an organ (or part of one) from one body to another, for the purpose of replacing the recipients damaged or failing organ with a working one from the donor. ...


Surgeries in which cardiopulmonary bypass is used

Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... The aortic valve is one of the valves of the heart. ... The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). ... The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle. ... In anatomy, the heart valves are valves in the heart that prevent blood from flowing the wrong way. ... Look up septum in Wiktionary, the free dictionary. ... Atrial septal defects (ASD) are a group of congenital heart diseases that enables communication between atria of the heart and may involve the interatrial septum. ... A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). ... Atrioventricular septal defect (AVSD) is characterized by a deficiency of the atrioventricular septum of the heart. ... A congenital heart defect is a defect in the structure of the heart and great blood vessels of the newborn. ... The tetralogy of Fallot is a congenital heart defect which classically has four anatomical components. ... Transposition of the great vessels (TGV) is a group of congenital heart defects (CHDs) involving an abnormal spatial arrangement of any of the primary vessels: superior and/or inferior vena cavae (SVC, IVC), pulmonary artery, pulmonary veins, and aorta. ... A heart-lung transplant is a procedure carried out to replace both heart and lungs in a single operation. ... An aneurysm (or aneurism) (from Gr. ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... A cerebral or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. ... In thoracic surgery, a pulmonary thromboendarterectomy, PTE, is an operation that removes organized clotted blood (thrombus) from the pulmonary arteries. ... In thoracic surgery, a pulmonary thrombectomy, is an emergency procedure that removes clotted blood (thrombus) from the pulmonary arteries. ...

History

John Gibbon is credited with developing the first truly practical heart-lung bypass machine; he performed the first successful surgery with it on May 6, 1953 in Philadelphia, an atrial septal defect repair. John Heysham Gibbon Jr. ... 1953 (MCMLIII) was a common year starting on Thursday. ... Nickname: Motto: Philadelphia maneto - Let brotherly love continue Location in Pennsylvania Coordinates: Country United States Commonwealth Pennsylvania County Philadelphia Founded October 27, 1682 Incorporated October 25, 1701 Government  - Mayor John F. Street (D) Area  - City 369. ... Atrial septal defects (ASD) are a group of congenital heart diseases that enables communication between atria of the heart and may involve the interatrial septum. ...


Components of cardiopulmonary bypass

Cardiopulmonary bypass consists of two main functional units, the pump and the oxygenator which remove oxygen deprived blood from a patients body and replace it with oxygen-rich blood through a series of hoses. An electrically driven pump (electropump) for waterworks near the Hengsteysee, Germany. ... This article does not cite any references or sources. ...


Tubing

The components of the CPB circuit are interconnected by a series of tubes made of silicone rubber, or PVC. The tubing in the CPB circuit is similar to transparent garden hose. Silicone rubber is a polymer that has a backbone of silicon oxygen linkages, the same bond that is found in quartz, glass and sand. ... PVC may refer to the following: Polyvinyl chloride, a plastic Premature ventricular contraction, irregular heartbeat Permanent virtual circuit, a term used in telecommunications and computer networks Param Vir Chakra, Indias highest military honor. ... See: transparency (optics) alpha compositing GIF#Transparency transparency (overhead projector) market transparency transparency (telecommunication) transparency (computing) For X11 pseudo-transparency, see pseudo-transparency. ... A garden hose or hosepipe is a kind of hose which is used for watering plants in a garden or a lawn. ...


Pumps

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. In much of the digestive tract, muscles contract in sequence to produce a peristaltic wave which forces food (called bolus while in the esophagus and chyme below the esophagus) along the alimentary canal. ... Linear peristaltic pump Linear peristaltic pump A peristaltic pump is a type of positive displacement pump used for pumping a variety of fluids. ...


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. This type of pumping action is considered to be superior to the action of the roller pump by many because it is thought to produce less blood damage (Hemolysis, etc.). Warman centrifugal pump in a CHPP application A Centrifugal Pump is a rotodynamic pump that uses a rotating impeller to increase the pressure of a fluid. ... Hemolysis (alternative spelling haemolysis) literally means the excessive breakdown of red blood cells. ...


Oxygenator

The oxygenator is designed to transfer oxygen to infused blood and remove 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. General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Carbon dioxide is a chemical compound composed of one carbon and two oxygen atoms. ... In the circulatory system, venous blood is blood returning to the heart. ... A membrane oyxgenator imitates the function of the lungs in cardiopulmonary bypass (CPB). ...


The oxygenator was first conceptualised in the 17th century by Robert Hooke and developed into practical extracorporeal oxygenators by French and German experimental physiologists in the 19th century. Bubble oxygenators have no intervening barrier between blood and oxygen, these are called 'direct contact' oxygenators. Membrane oxygenators introduce a gas-permeable membrane between blood and oxygen that decreases the blood trauma of direct-contact oxygenators. Much work since the 1960s focused on overcoming the gas exchange handicap of the membrane barrier, leading to the development of high-performance microporous hollow-fibre oxygenators that eventually replaced direct-contact oxygenators in cardiac theatres.[1] Robert Hooke, FRS (July 18, 1635 – March 3, 1703) was an English polymath who played an important role in the scientific revolution, through both experimental and theoretical work. ...


Another type of oxygenator gaining favour recently is the heparin-coated blood oxygenator which is believed to produce less systemic inflammation and decrease the propensity for blood to clot in the CPB circuit. For most cardiothoracic operations such as coronary artery bypass grafting, the cardiopulmonary bypass is performed using a heart-lung machine (or cardiopulmonary bypass machine). ...


Cannulae

Multiple cannulae are sewn into the patients body in a variety of locations, depending on the type of surgery. A venous cannula removes oxygen deprived blood from a patients body. An arterial cannula is sewn into a patient's body and is used to infuse oxygen-rich blood. A cardioplegia cannula is sewn into the heart to deliver a cardioplegia solution to cause the heart to stop beating. A cannula (pl. ... Cardioplegia is the intentional and temporary cessation of cardiac activity, primarily for use in cardiac bypass surgeries. ...

Venous Arterial Cardioplegia
Right atrium Proximal aorta, distal to the cross-clamp Proximal aorta, proximal to the cross-clamp
Vena cavae Femoral artery Coronary sinus (retrograde delivery)
Femoral vein Axillary artery Coronary ostia
Distal aorta Bypass grafts (during CABG)
Apex of the heart

This page is about the muscular organ, the Heart. ... The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ... An aortic cross-clamp is a surgical instrument used in cardiac surgery to clamp the aorta and separate the systemic circulation from the outflow of the heart. ... The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ... An aortic cross-clamp is a surgical instrument used in cardiac surgery to clamp the aorta and separate the systemic circulation from the outflow of the heart. ... The superior and inferior venae cavae are the veins that return the blood from the body into the heart. ... Femoral artery and its major branches - right thigh, anterior view. ... An aortic sinus is one of the anatomic dilations of the ascending aorta which occurs at the aortic root, i. ... Grays Fig. ... In human anatomy, the axillary artery is a large blood vessel that conveys oxygenated blood to the lateral aspect of the thorax, the axilla (armpit) and the upper limb. ... The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ... A coronary artery bypass graft (CABG) or heart bypass is a surgical procedure performed in patients with coronary artery disease (see atherosclerosis) for the relief of angina and possible improved heart muscle function. ... The heart and lungs, from an older edition of Grays Anatomy. ...

Cardioplegia

A CPB circuit consists of a systemic circuit for oxygenating blood and reinfusing blood into a patient's body (bypassing the heart); and a separate circuit for infusing a solution into the heart itself to produce cardioplegia (i.e. to stop the heart from beating), and to provide myocardial protection (i.e. to prevent death of heart tissue). Cardioplegia is the intentional and temporary cessation of cardiac activity, primarily for use in cardiac bypass surgeries. ...


Operation

A CPB circuit must be primed with fluid and all air expunged before connection to the patient. The circuit is primed with a crystalloid solution and sometimes blood products are also added. Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...


Complications

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 cause 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.

Postperfusion syndrome, also known as pumphead, is a controversial condition that describes a constellation of neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. ... Hemolysis (alternative spelling haemolysis) literally means the excessive breakdown of red blood cells. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... An air embolism, or more generally gas embolism, is a medical condition caused by gas bubbles in the bloodstream (embolism in a medical context refers to any large moving mass or defect in the blood stream). ... Exsanguination is the fatal process of total blood loss. ...

References

  1. ^ Lim M (2006). "The history of extracorporeal oxygenators". Anaesthesia 61 (10): 984-95. PMID 16978315. 

External links


  Results from FactBites:
 
Cardiopulmonary Bypass, Cincinnati Children's Hospital Medical Center (950 words)
In this way, cardiopulmonary bypass permits the patients' blood to bypass the heart and lungs, achieving the desired bloodless, motionless operative field and still supplying all the other organs of the body with a constant supply of oxygen and nutrient-rich blood.
Although the origins of cardiopulmonary bypass can be traced back to the 19th century, the field has developed rapidly in the last 50 years.
The risk of serious complications related to being placed on cardiopulmonary support depends on the age of the patient, how ill they are at the time of the operation and the complexity of the surgery to be performed.
Duke Anesthesiology - Basic Science Research - Cardiopulmonary Bypass Research Laboratory (212 words)
The cardiopulmonary research laboratory is an active basic science laboratory established to explore the mechanisms of cerebral injury following cardiac surgery utilizing a rodent model of cardiopulmonary bypass (CPB).
The influence of xenon, nitrous oxide, and nitrogen on gas bubble expansion during cardiopulmonary bypass.
Cardiopulmonary bypass induces neurologic and neurocognitive dysfunction in the rat.
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