From the Spinning Disc to the Membrane Oxygenator for Open-Heart Surgery

Abstract

Gibbon's rotating cylinder could not be enlarged to oxygenate an animal larger than a cat. The spinning disc oxygenator, introduced in 1947, had the capacity to perfuse a dog and the potential to increase oxygenation capacity by addition of more discs. When centers began to do three to four open-heart operations per day, the disposable bubble oxygenator was more practical. Bubble size was optimized to decrease the flow of oxygen relative to the blood flow and reduce trauma to blood. The bubble oxygenator is the type most commonly used today. Use of deep hypothermia with whole blood at an esophageal temperature of 10 degrees C was initially complicated by brain damage due to aggregation of white blood corpuscles and platelets. The introduction of hemodilution permitted safe utilization of hypothermic perfusion. Perfusion of infants should not be carried out at hematocrit below 25 ml/100 m. Early membrane oxygenators used nonporous silicone, or modified silicone membranes. High priming volumes, high pressure drop and marginal gas transfer efficiency characterized these devices. Recent advances in membrane technology have spawned a new generation of membrane oxygenators utilizing microporous polypropylene. In these new oxygenators, with either microporous hollow fibers or sheet membrane, the gas transfer characteristics are far superior to those of types produced in the past. The hollow-fiber devices typically have larger surface areas and higher pressure drop than in the new state-of-the-art flat plate models. An evaluation of one of these new-generation membrane oxygenators gave optimal oxygen and carbon dioxide exchange at a gas flow of 1 l/min of 60% oxygen in air at 30 degrees C and 2 l/min of 80% oxygen in air at normal temperature and rewarming for an adult. Today, after almost 40 years of oxygenator development, these new membrane device can offer better platelet preservation and reduced blood trauma as compared with types developed in the past. The new membrane oxygenators are fast becoming the preferred choice for use in infants and in protracted perfusion.

The scientific evidence of arterial line filtration in cardiopulmonary bypass

“…48 The introduction of membrane oxygenation during the late 1980s changed the scene completely. 49 Nonetheless, the use of arterial filters remained a core component of the extracorporeal circuit, more or less based on tradition, without questioning the indication. 8 Refinements in circuit design and the introduction of minimised cardiopulmonary bypass systems 50 have made the involvement of ALF even more complex.…”

Artificial Placenta - Lung Assist Devices for Term and Preterm Newborns with Respiratory Failure

“…This design was also flexible in that additional discs could be added to increase the oxygenation ability of the device. It was estimated that a device with 120 discs may have an oxygenation level of 5 l/min (25).…”

“…Goat newborns were cannulated using catheters with a diameter of 2.7–3.3 mm for the umbilical artery and 3.3–4 mm for the umbilical vein (29–33). Neonatal lambs were cannulated with 2–3.3 mm for arterial catheters and 3.3–4.7 mm for umbilical vein catheters (5, 24–26, 35). In these experiments, the length of the umbilical artery catheters was approximately 38 cm, while the umbilical vein catheters were 15 cm long (28).…”

Avaliação de oxigenador de membrana infantil em ovinos

“…In attempt to promote an oxygenation as close as possible to the physiological oxygenation, the membrane oxygenators were idealized and built [7,8].…”