Clinical Engineering. Equipment (Heart-lung machines)
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1 Clinical Engineering Clinical Engineering Equipment (Heart-lung machines) Syed Mohd Nooh Bin Syed Omar
2 Open Heart Surgery Coronary artery bypass grafting (CABG) Repair or replace valves Regurgitation) Repair abnormal or damaged structures in the heart (Septum) Heart transplant
3 Heart Lung Machine Cardiopulmonary bypass machine Provide blood flow and respiration for the patient while the heart is stopped Treatment provides removal of CO 2 from the blood, O 2 delivery to the blood, blood flow to the body + temperature maintenance Perfusion technologists
4 Heart Lung Machine Component : venous and arterial cannulae (tubes) PVC@ silicone venous reservoir membrane oxygenator heat exchanger / intercooler cardiotomy reservoir arterial line filter pump inline blood gas and electrolyte analyzer pressure monitoring devices
5 Cardioplegia System Venous Reservoir Arterial filter, Bubble Trap Oxygenator Cooler, Heater
6 Oxygenator Serves as the lung (expose the blood to oxygen) + disposable meters squared of membrane (permeable to gas & impermeable to liquid blood) Oxygen gas is delivered to the interface between the blood and the device, permitting the blood cells to absorb oxygen molecules directly Carbon dioxide is added to the sweep stream to maintain the proper blood gas level Type : Membrane
7 Bubble oxygenator O 2 and venous blood enter oxygenator O 2 bubbles mix with ascending blood stream and gas exchange occurs At the top of the column, the gases and blood form a foam from which the bubbles coalesce Oxygenated blood contacts chemical defoamer and exhaust gas is expelled Oxygenated blood leaves oxygenator before going on to filters and bubble traps
8 Membrane oxygenator venous blood enters oxygenator exchange takes place across membrane arterialised blood is collected in the outlet manifold and returned to the patient eliminates the need for a bubble blood contact & need for a defoamer ideal for perfusions lasting for > 2 3 hours 2 type of membrane solid silicone microporous polypropylene /teflon/polyacrylamide Heparin coated oxygenators
9 Comparison of oxygenator Bubble Advantage : cheap easier to set up relatively small primimng volumes adequate oxygenating capacity Disadvantage : Membrane expensive longer time to set up large priming volume prolonged used pores may get blocked
10 Comparison of oxygenator Bubble Disadvantage : increased risk of gaseous embolism and thrombosis poor compatibility long post operative recovery course blood cell trauma destruction of plasma protein due to gas interface excessive removal of CO2 defoaming capacity may get exhausted with time cannot use for extended CPB times Advantage : Membrane less damaging the blood better platelet preservation can be used longer shorter post operative recovery course (post op bleeding) can deliver air O2 mixtures decrease hemolysis decrease protein desaturation
11 Pump peristaltic pump The pump console usually comprises several rotating motor driven pumps that peristaltically "massage" the tubing This action gently propels the blood through the tubing 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)
12 Cardioplegia system Cardio heart & plegia paralysis To accomplishing asystole arresting or stopping the heart so that surgical procedures can be done How mild hypothermia (34 C) + cold crystalloid cardioplegic solution (4 C + dextrose, potassium chloride, and other ingredients) + via cannulae + at aortic roof
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