Historical vignettes concerning cardiopulmonary bypass without homologous blood and perfusion hypothermia

Litwak, Robert S.
May 2003
Perfusion;May2003, Vol. 18 Issue 3, p201
Academic Journal
Open intracardiac and aortic operations are commonly performed today without the need for homologous blood (HB) priming of the pump-oxygenator and, when clinical conditions permit, avoidance of HB infusion both intraoperatively and postoperatively. A second technical approach employed today is perfusion hypothermia. This report seeks to provide some historical landmarks concerning these two important components of our current perfusion armamentarium. If there ever was a bad news/good news event, it was the role the dog played in the investigative and later clinical decision to eliminate HB, not only as the priming perfusate, but, whenever possible, to minimize or totally avoid its use throughout and following the operation. In the mid- and late 1950s and early 1960s, a period when dogs were being utilized to investigate various types of pump-oxygenators, fresh heparinized HB was routinely employed to prime the units. Mortality in the dogs was consistently high, with the animals frequently manifesting severe arterial hypotension at the onset of cardiopulmonary bypass (CPB), accompanied by the development of portal hypertension with severe hepatic engorgement, hypovolemia with splanchnic sequestration of blood, arterial oxygen desaturation, diffuse liver-like consolidation of the lungs, and metabolic acidosis.


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