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Extracorporeal Blood Oxygenation

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Hemomath

Part of the book series: MS&A ((MS&A,volume 18))

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Abstract

Respiration is a complex vital process taking place in the lungs. Deoxygenated blood reaches the right atrium through the venae cavae (superior and inferior), is transferred to the right ventricle through the tricuspid valve, from which it is pumped to the lungs trough the two pairs of pulmonary arteries (left and right). The gas exchange between blood and air occurring in pulmonary alveoli is described in mathematical terms. Besides this aspect, in this chapter we will deal with machines helping or replacing the natural respiratory function with external blood oxygenation. These are the heart-lung machine for cardiopulmonary bypass used in particularly long and complex surgical operations, the extracorporeal membrane oxygenation (ECMO) or the alternative intravenous membrane oxygenator (IMO, or IVOX), and the newly developed machines combining an oxygenator (with the main task of removing CO 2) with a hemofilter.

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Notes

  1. 1.

    8-Methoxypsoralen. Methoxsalen is extracted from Ammi majus (a.k.a. Bishop’s weed), a plant familiar to ancient Egyptians who used it to treat some forms of dermatitis and which was known to make skin particularly sensitive to sunlight.

  2. 2.

    It exhibits four serious cardiac defects. More rarely three, but sometimes five (as Fallot himself pointed out) or even more.

  3. 3.

    Thomas was a young black man with no high education and with the dream of becoming a medical doctor. He was employed as a janitor at Vanderbilt University, where he met Dr. Blalock, who recognized his incredible talent and brought him to Baltimore, when he moved to Johns Hopkins. There Thomas had a hard life because of the color of his skin. Finally his merits were largely acknowledged and in 1976 he was awarded a honorary doctorate. His life became the subject of the movie Something the Lord made (2004).

  4. 4.

    Clarence Dennis (1909–2005) had used a machine of his invention in 1951, but only in 1955 he made the first successful operation. The Russian scientist Sergei Sergeyevich Brukhonenko (1890–1960) built a primitive form of heart lung machine (the autojector) as early as 1926. Experiments were performed on dogs during 1939, but the first Soviet operation was performed in 1957 (by A.A. Vishnevsky).

  5. 5.

    The first prosthetic heart valve was invented by the American surgeon Albert Starr (b. 1926) in 1961.

  6. 6.

    This fundamental device was manufactured by Earl Bakken (b.1924), American engineer and philanthropist, the founder of Medtronic, on request of Lillehei, who, during a blackout had lost a patient attached to an externally powered pace maker. He adapted a transistorized circuit from a metronome developed at MIT during world war II producing a prototype of wearable pace maker that was readily implanted by Lillehei and worked perfectly (good days of no bureaucracy!). The way was opened for the invention of a fully implantable pace maker. It was a Swedish surgeon, Ake Senning (1915–2000), to perform the first operation of that kind (1958).

  7. 7.

    COPD affects 5% of the population worldwide and has a huge economic and social impact.

  8. 8.

    The first artificial heart was implanted by Domingo Liotta and Denton Cooley in 1969 in Houston. The patient received a transplanted heart after a few days, to which he survived less than 2 days owing to the rejection phenomenon. The operation, for which a large press covering had been arranged, was supposed to be performed by DeBakey, who had rescheduled it because of other engagements. Cooley, at that time a colleague of DeBakey, took over and operated in his absence without consulting him, thus linking his own name to that already announced historical medical event. The two reconciled only in 2007.

  9. 9.

    The first heart transplantation (3 December 1967) made the name of the South African surgeon Christiaan Barnard (1922–2001) worldwide famous. The recipient was Louis Washkansky who died from pneumonia after 18 days. Only 3 days later, on December 6, in Brooklin, N.Y., Adrian Kantrowitz (1918–2008) performed the first pediatric heart transplantation. It was however Norman Edward Shumway (1923–2006) who gave the greatest contribution to solve the problem of immune rejection.

  10. 10.

    The physician Joseph-Ignace Guillotin (1738–1814) involuntarily linked his name to the beheading instrument. Though he opposed death penalty he suggested that a device quickly cutting the head was a humanitarian way of applying death sentences. That was also democratic, since till then beheading was an upper class “privilege”, but required a particular expertise to avoid a miserable outcome. Ordinary criminals were hanged. The device was actually built soon later by Antoine Louis (1723–1792) (also a physician), but named after Guillotin because his speech in favour of the invention had become famous. The legend that he himself finished his life under the falling blade is false and was originated by the fact that another Guillotin, a medical doctor from Lyon, was guillotined.

  11. 11.

    The ostentation of his sexual vigor, that he claimed to keep young by assuming a preparation with extracts of monkey (and other animals) testicles, stimulated the search for what today we call hormones.

  12. 12.

    He studied medicine, physics and mathematics!

  13. 13.

    PHYSBE (Physiological Simulation Benchmark Experiment) was first developed in 1966 by John McLeod [45].

  14. 14.

    The French (length unit) is the unit for catheters diameters. 1Fr = 1∕3 mm.

  15. 15.

    From [65]. This is a generalization of the Henderson–Hasselbalch equation, well known to biochemists, for the pH resulting from the dissociation of a weak acid in water.

  16. 16.

    The English chemist William Henry (1774–1836) formulated it in 1803.

  17. 17.

    If concentrations are dimensionless, then k = 863 mmHg.

  18. 18.

    From [42].

  19. 19.

    Named after the English scientist Abdul Gilbert Smithson Adair (1896–1979), who studied the oxidative reactions of hemoglobin. Adair provided purified hemoglobin to Max Perutz for his celebrated studies (see Sect. 1.3.1). Research in the field of oxygen-hemoglobin reaction was pioneered by the Danish physician Christian Bohr (1855–1911), the father of the famous Nobel laureate nuclear physicist Niels Bohr (in turn father of Aage Bohr, who got a Nobel prize too in nuclear physics). We have seen that Linus Pauling’s studies on hemoglobin explained the causes of SCA (Sect. 2.5). He provided his own version of Adair formula. Thus hemoglobin has fascinated many illustrious scientists.

  20. 20.

    Identified by the English physician John Cheyne (1777–1836) in 1818 and independently, but much later, by the Irish physician William Stokes (1804–1878) in 1854.

  21. 21.

    The amount of oxygen dissolved in plasma is only 2% of the total content [54].

  22. 22.

    The mass transfer resistance is the reciprocal of the mass transfer coefficient K, defined so that the product K ⋅ Δc gives the mass transfer rate per unit area between two phases, driven by the concentration difference Δc.

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Authors and Affiliations

  1. Fabbrica Italiana Apparecchi Biomedicali (FIAB), Università degli Studi di Firenze, Firenze, Italy

    Antonio Fasano

  2. Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal

    Adélia Sequeira

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Fasano, A., Sequeira, A. (2017). Extracorporeal Blood Oxygenation. In: Hemomath. MS&A, vol 18. Springer, Cham. https://doi.org/10.1007/978-3-319-60513-5_5

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