Middle Technical University

Electrical engineering technical college

Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Open heart & cardiovascular-heart-lung machine
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(21th, 22th and 23th Weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1. Overview
A-Target population: -
For students of the fourth stage in electrical engineering technical college in middle
technical university.
B- Rational: -
Give a comprehensive overview about Heart-lung machine and its role in the operating
Room and its other uses in the medical field
C- Central ideas
1. Definition heart lung machine
2. Working principle of this device.
3. Characteristics of all parts and their specifications
D- Objectives: -

After studying the heart lung machine, the student will be able to
1. Define of heart lung machine
2. Understand working principle of heart lung machine
3. Know all parts of this system

2. Pre test
Q: put True or False
1. The heart-lung machine takes over the functions of the heart and lungs
2. Heart-lung machines work by withdrawing bluish, unoxygenated blood from the upper
heart chambers through a tube into a reservoir.
3. The pumps must be designed to have flow rates up to 2 liters per. minute with a
pressure head up to 20 mm Hg.
3. Theory: -

The Cardiopulmonary Bypass Circuit (heart-lung machine)

It is one of the truly revolutionary machines of medical equipments has been the
invention and development of heart-lung machine. During an open heart surgery, such a
bypass surgery, the heart lung machine takes over the functions of heart and lung and
allows the surgeon to carefully stop the heart while the rest of the patients' body
continues to receive oxygen-rich blood. The surgeon can perform the work on heart
without interference from bleeding or heart pumping motion. Once the procedure is over,
the surgeon starts the heart and disconnects the heart lung machine.

The principle of the heart-lung machine (also known as pump-oxygenator or

cardiopulmonary bypass) is actually quite simple. Deoxygenated blood withdrawn from
the upper heart chambers is drained into a reservoir. From there, the blood is pumped
through an artificial lung. This component is designed to expose the blood to oxygen. As
the blood passes through the artificial lung (also known as an oxygenator), the blood
comes into intimate contact with the fine surfaces of the device itself.
Oxygen gas is delivered to the interface between the blood and the device, permitting
the blood cells to absorb oxygen molecules directly. Now the blood becomes
oxygenated blood. Finally the heart-lung machine actively pumps the oxygenated blood
back into the patient through a tube connected to the arterial circulation. The heart-lung
circuit is a continuous loop, as the oxygenated blood goes into the body, deoxygenated
blood returns from the body and is drained into the pump completing the circuit.

Typically, blood is drained cannulas in the superior and inferior vena cavae (SVC, IVC)
or IVC and right atrium (RA) to the heart–lung machine where it is pumped through the
artificial lung back into the body via an arterial cannula placed in the ascending aorta.
The modern heart-lung machine is actually more sophisticated and versatile than the
overview given above. In fact, the pump oxygenator can do a number of other tasks
necessary for safe completion of an open heart operation. Firstly, any blood which
escapes the circulation and spills into the operating field around the heart can be
suctioned and returned to the pump. Returning shed blood into the heart-lung machine
greatly preserves the patient's own blood stores throughout the operation.
Secondly, the patient's body temperature can be controlled by selectively cooling or
heating the blood as it moves through the heart-lung machine. Thus the surgeon can
use low body temperatures as a tool to preserve the function of the heart and other vital
organs during the period of artificial circulation.
And the bypass pump has connectors into which medications and anesthetic drugs can
be given. In this way, medications arrive to the patient almost instantly by simply adding
them to the blood within the heart-lung reservoir.
To initiate heart-lung bypass, the surgeon must first impair the body’s own clotting
system. Otherwise, the patient’s blood would immediately clot upon exposure to the
plastic tubing and artificial surfaces inside the heart-lung machine itself. Thinning of the
blood (or anticoagulation) is done by first administering a powerful anticoagulant called
heparin.
Once clotting is impaired, a large drainage tube is placed in the upper chamber of the
heart (called the right atrium). This tube drains the deoxygenated blood from the patient
into the heart-lung machine. Then a smaller tube is placed into the arterial system so
that red blood can be returned to the patient’s body where it is needed. The most
common site for this tube is in the aorta.
So the modern Heart-lung machine can perform the following tasks:
1- Oxygenation of blood
2- Controlling the patient body temperature.
3- Adding medication and anesthetic drugs to the blood through the machine during
the surgery.
In spite of these advantages, there are some substantial disadvantages in this machine,
some of these are:
1- Formation of blood clots which may lead to a stroke, heart attack or kidney failure.
2- This machine can also trigger inflammatory process that can damage many body
systems and organs.
3- In rare cases, memory loss may occur.

Because of these disadvantages, biomedical engineers are developing the surgical tool,
imaging and robotics technologies for what is known "minimal invasive surgery" instead
of open heart surgery, and thus elimination the need for this machine.
The Heart Lung Machine is composed of three main parts:
1- The Pumps: these pumps are required to circulate the blood between the body
and the machine.
2- Oxygenator: this part is required to oxygenate the blood.
3- Heat Exchanger: this part is necessary to regulate the temperature of the blood
and thus the temperature of the body.

Design Aspects of Heart-Lung Machine

To serve the natural function of heart and lung, the machine should be able to arterialize
up to 5 liters per minute of venous blood from 65% oxygen saturation to more than 95%,
the carbon dioxide must be adequate. It should cause the least trauma and damage to
the blood particles.

Pumps design,
Peristaltic pumps are used for providing flow through the systemic line back into the
patient. The pump must be designed to have flow rate up to 5 liters per minute with a
pressure head up to 200mm Hg. The roller occludes the tube and displaces the fluid.
The pump should be double roller that has a wide flow range which is varied by varying
the speed of rotation.
The pump rotation speed should be variable from 0-180rprn. The pump has two heads
and each head is driven by 1/8 hp single phase AC motor. Speed variation can be
accomplished by Voltage/frequency speed variation principle.
Complications associated with roller pumps include: malocclusion, miss calibration, or
miscalculation including setting the wrong tube size into the pump controller; fracture of
the pump tubing; loss of power; spallation; and pumping of large amounts of air. If the
outflow becomes occluded, pressure in the line will progressively rise until the tubing in
the pump ruptures or connectors and tubing separate. This can be avoided by use of a
pressure-regulated shunt between the outflow and inflow lines of the roller pump or use
of servoregulation of the pump to arterial line pressure so that it turns off when excessive
pressures are detected. If inflow becomes limited, the roller pumps will develop high
negative pressures producing cavitation, and microbubbles.
Centrifugal pumps consist of a nest of smooth plastic cones or a vaned impeller located
inside a plastic housing. When rotated rapidly (2,000 to 3,000 rpm), these pumps generate
a pressure differential that causes the movement of fluid. Unlike roller pumps, they are
totally nonocclusive and afterload dependent (i.e., an increase in downstream resistance
or pressure decreases forward flow delivered to the patient if no adjustment is made in
the rpm). This has both favorable and unfavorable consequences. Flow is not determined
by rotational rate alone, and therefore a flowmeter must be incorporated in the outflow line
to quantitate pump flow. Furthermore, when the pump is connected to the patient's arterial
system but is not rotating, blood will flow backward through the pump and out of the patient
unless the CPB systemic line is clamped. This can cause exsanguination of the patient or
aspiration of air into the arterial line. Thus, whenever the centrifugal pump is not running,
the arterial line must be clamped, or a check valve is used to prevent this problem .
On the other hand, if the arterial line becomes occluded, these pumps will not generate
excessive pressure (the maximum is only about 700 to 900 mm Hg) and will not rupture
the systemic flow line. Likewise, they will not generate as much negative pressure and
hence as much cavitation and microembolus production as a roller pump because the
maximum is only about –500 mm Hg if the inflow becomes occluded.
A reputed advantage of centrifugal pumps over roller pumps is less risk of passing
massive air emboli into the arterial line. This is because they will become deprimed and
stop pumping if more than approximately 50 mL of air is introduced into the circuit.
However, they will pass smaller but still potentially lethal quantities of smaller
bubbles.
Design of the Oxygenator
The oxygenator must be able to oxygenate up to 5 liters per minute from 65% oxygen
saturation to 95% before the blood enter the physiological system. The natural lung have
a wide surface area of about 50-100cm2 so the blood as a film of thickness of 0.005-
0.01mm get oxygenated in a contact time of 40-50mSec. The inability to provide such
extended surface area and thin blood film offers the greatest resistance to the oxygen
transfer, this led the biomedical engineers to invent a rotating machine for oxygenation.
To provide such an environment, the disk oxygenator is used as shown in the next figure.
It consists of a cylindrical glass vessel of 15cm internal diameter, 38cm long in which 80-
100 stainless steel disks of 0.6mm thickness and 14cm diameter are mounted axially with
3mm spacers between the discs. The shaft on which the discs are mounted is hollow and
supported by three ill bearings at the end. The oxygen is fed through the axis of the shaft
and it enters the oxygenator through the distributing apertures on the circumstance of the
shaft.
The optimum blood level in the oxygenator that provides the maximum film area for a
given priming volume is 0.7R where R is the radius of the disc. For this blood level in the
oxygenator, the values of the various design parameters as number of discs, diameter of
discs, and length of the oxygenator are determined for given requirements of oxygenation.
For this disc oxygenator, with blood level of 0.7R, the available film area is 1.47m2 and
the prime volume is 2.19 liters. To oxygenate 5 liters per minute of blood would require a
rotating speed of about 150r.p.m. The oxygenation capacity can be varied, by varying
rotating speed or by changing the number of discs.
The blood level is a photo-electric level sensor. The sensing element is a photo conducting
cell which conducts depending on the light radiation it receives. The light source is fixed
on the top of the oxygenator shown in the next figure, and the light reaching the
photodiode depends on the blood level in the oxygenator. If we know the signal
corresponding to the blood level 0.7R, we can suitably adjust the pump flow rate. Manual
control is replaced by feedback control of the power supply of the motor using the signal
from the photo sensor.
Heat Exchanger:
The heat exchanger is single pass, shell and tube heat exchanger with blood flowing on
the shell side and water flowing on the tube side. The priming volume of heat exchanger
is about 250 ml and blood flows as thin film in the space between shell and tube. The
temperature of blood stream and water stream are monitored.
The Cardiopulmonary Bypass Circuit
A simplified circuit of heart-lung bypass circuit is shown below. One of the pumps is
connected to the suction line and the other on the arterial line. Oxygen flow is regulated
in the range of 0-15 liters per minute with a rotameter and needle valve flow controller.
The arterial and venous pressures gauges are provided. The blood from the heat
exchanger is passed through a bubble trap before it is returned to the patient. The role of
physical factors such as oxygen saturation of incoming blood, the blood distributing
system in the oxygenator, oxygen carrying capacity of the blood under given conditions,
the blood flow rate, temperature of the oxygenation, partial pressures of the oxygen etc..
All tell upon the performance of the oxygenator.

More detailed circuit of heart-lung bypass circuit is shown below.

4. Self-test : -
Q: Put true or false in front of each of the following sentences
1. Oxygen flow is regulated in the range 0–5 liters per minute with a rotameter and
needle valve flow controller.
2. The heat exchanger is a single pass, shell and tube heat exchanger with blood
flowing on the shell side and water flowing on the tube side
5. Post test
Q: fill in the blanks with appropriate word (s)
1. A reputed advantage of centrifugal pumps over roller pumps is ------
2. Centrifugal pumps consist of a ----------- or ------------ located inside a plastic housing
6. Key answer
Pre test solution
1. T 2. T 3. F
Self-test solutions
1. F 2. T
Post test
1. Less risk of passing massive air emboli into the arterial line
2. A nest of smooth plastic cones or a vaned impeller

7. References
S. Ananthi,2005,”A text book of medical instruments”