Heart-lung machines take over the function of the heart and lungs during surgery, allowing surgeons to operate on a still heart. They were first developed in the 1950s and use cardiopulmonary bypass to oxygenate the blood. The machine is operated by a perfusionist and has revolutionized open heart surgery. Extracorporeal membrane oxygenation (ECMO) is a similar machine used to replace damaged hearts and/or lungs.
A heart-lung machine is medical equipment designed to take over the function of the heart and lungs during surgery so that a surgeon can operate in a relatively bloodless field on a heart that doesn’t move. While this may sound simple enough, heart-lung machines are actually very complex, and it took a lot of trial and error to develop an effective machine that solved problems like blood bubbles, body temperature, and clotting.
The first heart-lung machines were developed in the 1950s. The technology involves inserting cannulas to divert blood from the heart to the heart-lung machine. As the blood passes through the machine, it is oxygenated and then returned to the body. This process is known as cardiopulmonary bypass or simply bypass. Once the surgery is complete, the patient can be removed from the bypass to allow the heart and lungs to return to their normal functions.
Heart-lung machines can use bubble oxygenation or membrane oxygenation to oxygenate the blood, depending on the design. The device moves blood through the tubes with the use of rollers that apply pressure to the tubes, rather than a mechanical pump, to avoid creating bubbles that could injure or kill the patient. The patient should also be given an anticoagulant to prevent clotting, as blood can react with materials in the tubes and clump together.
The heart lung machine is operated by an allied healthcare professional known as a perfusionist. The perfusionist is responsible for setting up the equipment correctly, monitoring the patient while on bypass, and alerting the surgeon to any problems that arise. The development of the heart-lung machine led to a revolution in open heart surgery, as surgeons found their repertoires radically expanded. Defects and injuries that would have been impossible to repair have become routine fixes and many lives have been saved as a result.
A related concept, extracorporeal membrane oxygenation (ECMO) involves the use of a machine similar to a heart-lung machine to replace damaged hearts and/or lungs. This is most commonly seen in intensive care units and is designed to provide support as the body heals, with the patient eventually being taken off the ECMO. Patients with damage that has progressed so far that their hearts and lungs will never be able to function are transplant candidates, who can use ECMO while they wait for a donor organ to become available.
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