Transcript History of Perfusion - cardiac anesthesia basics

History of Perfusion
Brian Schwartz, CCP
September 2, 2003
Perfusion I
Introduction
• Before 1952 Physicians had no means of
treating patients with intracardiac
malformations
• With the development of the heart and
lung machine, surgeons were able to
operate on patients who were once
considered “non-operatable”
Historical Time-Line
• 1952: Lewis performed the first open heart
surgery (repair of an ASD).
• Used inflow occlusion and general hypothermia
• 1953: Gibbon performed many cases
utilizing CPB; yet he only had one success
• 1954: Lillehei used “cross-circulation” for
the closure of a VSD
Historical Time-Line (cont)
• Late 1950’s: Kirklin used the film
oxygenator in a large number of patients
• May of 1955: The DeWall-Lillehei bubble
oxygenator became the method of choice
to oxygenate venous blood during open
heart surgery
• Membrane oxygenator developed and
used from the 50’s to the 70’s
Historical Time-Line (cont)
• 1980’s: Design changed with regards to
the membrane oxygenator…now
microporous, making it the choice of
oxygenators
• Priming the heart and lung machines with
non-blood solutions was a major advance
in heart sugery
• Improved tissue perfusion
• Reduced hemolysis
• Avoided exposure to donor blood
Reasons Why Initial Results were
Discouraging
• Flow rates were too high
• Poor visibility
• Pumping air to patient
Controlled Cross-Circulation for
Cardiopulmonary Bypass
• The thought of using “cross-circulation” for
cardiac surgery led to huge debates within
the medical community
• With this method physicians used a
“normal human being” to provide donor
circulation
• This technique for ECC was utilized for 45
operations, with no donor
mortality/morbidity.