HEART-LUNG MACHINE

eng. Hassanain Ali Lefta Mossa * , HasAli76@yahoo.com

During an open-heart surgery (such as valve surgery), an extracorporeal (i.e. outside the body)
equipment called the heart-lung machine takes over the functions of the heart and lungs, so
that the heart can be carefully stopped while the vital organs continue to receive blood and
oxygen. The surgeon can then operate in a blood-free surgical field without interference from
bleeding or the heart's pumping motion.

The principle of the heart-lung machine (also known cardiopulmonary bypass) is actually quite
simple. It permits the heart to be operated on safely by maintaining the circulation of
oxygenated blood throughout the cardiovascular system. It represents a continuous loop; as
the rich-oxygen blood goes into the body, poor-oxygen blood returns from the body and is
drained into the pump completing the circuit.

The machine basically consists of a pump (to replace the heart) and an oxygenator (to replace
the lungs). Acting as a mechanical heart and lungs, it keeps oxygen-rich blood flowing
throughout the body after the patient's heart has been carefully stopped. In a process called
perfusion , the machine receives the patient's blood, removes the carbon dioxide and other
waste products, adds oxygen, warms (or cools) the blood and pumps it back through the body.
Cooling the blood, in turn, lowers body temperature. This helps protect the body's organs
while the heart-lung machine is in use. After the surgery is completed, the heart is restarted,
the heart-lung machine is stopped and the machine is disconnected from the patient.

Once using a heart-lung machine during open-heart surgery, a powerful anticoagulant,

Heparin should be given to the patient in order to reduce the blood's ability to clot, reducing
the risk of clots forming in the heart-lung machine and within the tubes connected to the heart.

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* B.Sc. in Biomedical Engineering from Baghdad University, Iraq 2000.
M.Sc. in Medical Engineering from Al-Nahrain University, Iraq 2004.

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The heart-lung machine can perform other tasks. It can directly deliver medications and
anesthetic drugs into the recirculated blood. In this way, medications arrive to the patient
almost instantly by simply adding them to the blood within the heart-lung reservoir. It can also
minimize blood loss by vacuuming up and recirculating any blood that may get into the
surgical field.

The shown below diagram illustrates a heart-lung machine pump head. This type of
mechanism is called a peristaltic pump. The blood to and from the patient's body is carried in
a length of sterile, clear plastic (polyvinyl chloride) tubing known as cannulas. These cannulas,
with appropriate fittings to accommodate the tubing, are inserted into the vessels to take blood
from, and deliver blood to, the patient. Pumping action occurs because the rollers on the
rotating arm compress the tubing carrying the blood, forcing the blood ahead of the
compressed section. This peristaltic action produces a wave like, pulsatile flow of the blood
through the tubing system.

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The heart-lung machine, schematically shown below, uses five pump heads; one for perfusion
of the body, two suckers and two for perfusion of the coronary arteries.

The main perfusion system includes pump head 1 and a combination heat exchanger /
oxygenator. Some models separate these units, having separate oxygenator and heat exchanger
devices. The heat exchanger consists of water coils isolated from, but thermally coupled to, the
blood. A temperature controller permits the pump operator to keep the blood at a proper
temperature and compensate for heat loss through radiation from the lines.
The input port of the oxygenator / exchanger assembly is called the O2 –minus side, while the
output port is called the O2 –plus side.

Blood is taken from the patient's venae cava. A cannula is placed into the superior venae cava
and another into the inferior venae cava. These lines are joined into a single piece of tubing
through a Y-adapter. The blood flows from the venae cavae through the tubing to the O2 –
minus side of the oxygenator / exchanger assembly. Another length of tubing carries blood
from the O2 –plus side of the assembly, through a cannula inserted into the femoral artery.
Pump heads 2 and 3 are used as suckers. Pump head 2 has a vent function to perform in the
heart, while pump head 3 is shown as a suction device.

The surgeon can use the suction tip to collect blood that pools during surgery; this blood is
ordinarily lost unless it is auto-transfused back to the patient. Blood from the suckers is
delivered to a reservoir tank, and then transferred into the oxygenator / exchanger assembly
on the O2 –minus side. The purpose of pump heads 4 and 5 is to perfuse the coronary arteries.
A piece of tubing is routed from a port on the O2 –plus side of the oxygenator through the
pump heads to the cannulas placed in the coronary arteries.

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The heart-lung apparatus is provided with controls that automatically maintain the proper
temperature, maintain the pH of the blood at its correct value and safeguard the patient
against unwanted changes in the volume and pressure of the blood.

The temperatures of the patient and the blood are both recorded automatically at frequent
intervals. Blood temperature is controlled by a thermostat and electric heater in the
recirculation loop. The pH controller measures the pH value of the blood and adjusts the
admission of carbon dioxide to the oxygenator so as to maintain the pH near its correct level of
(7.38). The maintenance of the correct pH level is essential if the blood is to perform its proper
function for oxygen-carbon dioxide transport to and from the tissues of the body.

The design of heart-lung machine should involve the four major considerations:

1) The artificial lung to accomplish the required gas transfer.

2) The mechanical pumps to replace the heart action in moving the blood from the patient's
low-pressure venous system through the machine and back into the patient's higher-
pressure arterial system.
3) The handling of the blood itself, which raises questions of chemistry, materials of
construction and surgical cleanliness.
4) The system of control to provide for as much automatic performance as possible during the
course of the operation.
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