Heart-lung Machine

The heart-lung machine is a device used to provide blood circulation and oxygenation while
the heart is stopped. It is a means of keeping a patient alive while his heart is stopped or even
removed from his body. Usually called the heart-lung machine, the device also is referred to
as cardiopulmonary bypass, indicating its function as a means to substitute for the normal
functions of the heart (cardio) and lungs (pulmonary).

It is the function of the heart to provide circulation of blood at all times. It pushes blood out
into the body and through the lungs. It must function every minute of every day of life to
maintain the health of the tissues throughout the body.

The treatment provides removal of carbon dioxide from the blood, oxygen delivery to the
blood, blood flow to the body, and temperature maintenance. Pediatric and adult patients both
benefit from this technology.

Components
The machine consist of

• Venous and arterial cannula (tubes)

• Polyvinyl chloride (PVC) or silicone tubing
• Reservoir (to hold blood)
• Bubbler or membrane oxygenator
• Cardiotomy (filtered reservoir)
• Heat exchanger(s)
• Arterial line filter
• Pump
• Flow meter
• Inline blood gas and electrolyte analyzer
• Pressure-monitoring devices.

Performing treatment using Heart-lung

Machine
To function, the heart-lung machine must be connected to the patient in a way that allows
blood to be removed, processed, and returned to the body. Therefore, it requires two hook-
ups. One is to a large artery where fresh blood can be pumped back into the body. The other
is to a major vein where "used" blood can be removed from the body and passed through the
machine.

In fact, connections are made on the right side of the heart to the inferior and superior vena
cavae (singular: vena cava). These vessels collect blood drained from the body and head and
empty into the right atrium. They carry blood that has been circulated through the body and is
in need of oxygenation. Another connection is made by shunting into the aorta, the main
artery leading from the heart to the body, or the femoral artery, a large artery in the upper leg.
Blood is removed from the vena cavae, passed into the heart-lung machine where it is cooled
to lower the patient's body temperature, which reduces the tissues' need for blood. The blood
receives oxygen which forces out the carbon dioxide and it is filtered to remove any detritus
that should not be in the circulation such as small clots. The processed blood then goes back
into the patient in the aorta or femoral artery.

During surgery the technician monitoring the heart-lung machine carefully watches the
temperature of the blood, the pressure at which it is being pumped, its oxygen content, and
other measurements. When the surgeon nears the end of the procedure the technician will
increase the temperature of the heat exchanger in the machine to allow the blood to warm.
This will restore the normal body heat to the patient before he is taken off the machine.

Purpose
In the operation theatre, the heart-lung machine is used primarily to provide blood flow and
respiration for the patient while the heart is stopped.

Surgeons are able to perform coronary artery bypass grafting (CABG), open-heart surgery for
valve repair or repair of cardiac anomalies, and aortic aneurysm repairs, along with treatment
of other cardiac-related diseases.

The heart-lung machine provides the benefit of a motionless heart in an almost bloodless
surgical field. Cardioplegia solution is delivered to the heart, resulting in cardiac arrest (heart
stoppage). The heart-lung machine is invaluable during this time since the patient is unable to
maintain blood flow to the lungs or the body.

In critical care units and cardiac catheterization laboratories, the heart-lung machine is
used to support and maintain blood flow and respiration. The diseased heart or lung(s) is
replaced by this technology, providing time for the organ(s) to heal. The heart-lung machine
can be used with venoarterial extracorporeal membrane oxygenation (ECMO), which is used
primarily in the treatment of lung disease. Cardiopulmonary support is useful during
percutaneous transluminal coronary angioplasty (PTCA) and stent procedures performed with
cardiac catheterization. Both treatments can be instituted in the critical care unit when severe
heart or lung disease is no longer treatable by less-invasive conventional treatments such as
pharmaceuticals, intra-aortic balloon pump (IABP), and mechanical ventilation with a
respirator.

Use of this treatment in the emergency room is not limited to patients suffering heart or lung
failure. In severe cases of hypothermia, a patient's body temperature can be corrected by
extracorporeal circulation with the heart-lung machine. Blood is warmed as it passes over the
heat exchanger. The warmed blood returns to the body, gradually increasing the patient's
body temperature to normal.

Tertiary care facilities are able to support the staffing required to operate and maintain this
technology. Level I trauma centers have access to this specialized treatment and equipment.
Being that this technology serves both adult and pediatric patients, specialized children's
hospitals may provide treatment with the heart-lung machine for venoarterial ECMO.
Risks
While the heart bypass machine has improved greatly in recent years, there are still risks
associated with the use of the pump.

• Bleeding: Risk is increased due to the blood thinning medications used during
pumping.
• Blood clots
• Stroke: Cardiopulmonary bypass increases the risk of clots that may travel to the
brain.
• Kidney or lung damage
• “Pump head”: In some patients, the use of the cardiopulmonary bypass pump can
cause foggy thinking and confusion after surgery.