Early techniques of extracorporeal circulation

Kurusz, Mark
May 2003
Perfusion;May2003, Vol. 18 Issue 3, p191
Academic Journal
This article focuses on techniques of extracorporeal circulation used prior to 1960 and as reported by the pioneers. A variety of equipment and safety devices were used, and a myriad of set-up and cannulation techniques were described. Sterilization of all blood contacting components, an issue taken for granted today, was yet one more stumbling block in the transition to safe and reproducible results using cardiopulmonary bypass for cardiac surgery. Perfusion hypothermia did not gain wide acceptance until the late 1950s, and temperature management in early cases consisted primarily of maintaining the animals' and patients' temperatures normothermic. Insofar as the equipment used is fundamental in the management of extracorporeal circulation, it is also briefly discussed. In the early 1960s, primarily due to increased demands on blood banks and because of the reduced priming volume required for the DeWall-Lillehei disposable oxygenator, dextrose 5% in water was used exclusively without donor blood. The ability to manipulate large bubbles to coalesce smaller ones adherent within the tubing when priming was described by M.B. McKenzie, who also advocated discarding some of the clear prime and replacing it with the patient's blood before starting perfusion. He also was perhaps the first to suggest tapping the circuit with a patellar hammer as an aid to debubbling. The benefit of prebypass recirculation through an arterial-venous loop to deair the circuit and test the security of connections was also recognized early.


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