Gibbon Develops the Heart-Lung Machine

Date Fall, 1934-May 6, 1953

John H. Gibbon, Jr., developed and tested, in animals and then humans, the first artificial device to oxygenate and circulate blood during surgery. The machine made open-heart surgery possible.

Also known as Pump-oxygenator

Locale United States

Key Figures

• John H. Gibbon, Jr . (1903-1973), American cardiovascular surgeon
• Mary Hopkinson Gibbon (fl. mid-twentieth century), American research technician
• Thomas J. Watson, Sr. (1874-1956), founder and head of IBM
• T. L. Stokes (fl. mid-twentieth century), researcher in Gibbon’s laboratory
• J. B. Flick (fl. mid-twentieth century), researcher in Gibbon’s laboratory
• Bernard J. Miller (fl. mid-twentieth century), American cardiovascular surgeon and research associate
• Cecelia Bavolek (fl. mid-twentieth century), first human to undergo successful open-heart surgery using the heart-lung machine

Summary of Event

In the first half of the twentieth century, cardiovascular medicine had many triumphs. Effective anesthesia, antiseptic conditions, and antibiotics made surgery of all kinds safer; blood typing, anticlotting agents, and blood preservatives made blood transfusion practical; cardiac catheterization (feeding a tube into the heart), electrocardiography (noninvasive measurement of the electrical changes in the heart caused by its beating), and fluoroscopy (visualizing living tissues with an X-ray machine) made the nonsurgical diagnosis of cardiovascular problems possible. These advances were put to use solving problems of disease, injury, and birth defects in blood vessels and around the heart.

Before the 1950’s, however, there was no safe way to treat damage or defects within the heart. To make such a correction, the vital organ’s function must be interrupted, and the body’s tissues must be kept alive artificially during that interruption. Some surgeons practiced so-called blind surgery, inserting a finger into the heart through a small incision to attempt to make corrections without observing what they were doing; others attempted to reduce the body’s need for circulation by slowly chilling the patient until the heart stopped. Still other surgeons used “cross-circulation,” a procedure in which the patient’s circulatory system was temporarily connected to a donor’s system. All these approaches carried profound risks of hemorrhage, tissue damage, and death.

Not until the successful development of the pump-oxygenator, or heart-lung machine, did heart surgery as it is known today become possible. The heart-lung machine uses mechanical devices to oxygenate and circulate the blood during heart surgery. It was developed over a period of more than twenty years through the persistence of John H. Gibbon, Jr., who, on May 6, 1953, first used it successfully in a human being.

Ironically, Gibbon’s first interest in such a machine arose from his concern for a patient with an obstruction of lung circulation rather than a heart defect. In February of 1931, Gibbon witnessed the death of a young woman whose lung circulation was blocked by a blood clot. Because her blood could not pass through her lungs, she slowly lost consciousness from lack of oxygen. As he monitored her pulse and breathing, Gibbon thought about ways of circumventing the obstructed lungs and straining heart and providing the required oxygen to the rest of her body. Because surgery to remove such a blood clot in the pulmonary artery was often fatal, her surgeons operated only as a last resort. Their reluctance proved appropriate: Although the surgery took only 6.5 minutes, the young woman never regained consciousness.

This experience prompted Gibbon to pursue what few people then considered a practical line of research. At the time, researchers were still experimenting with separate devices for pumping blood during transfusion or for oxygenating blood during isolated perfused-organ experiments. Gibbon, however, sought to create a device capable of doing both at once, circulating blood around the heart and oxygenating it. If such a device could be created, it would permit the treatment of not only pulmonary obstruction but also abnormalities of the heart.

Gibbon began the project in earnest in the fall of 1934, when he returned to the laboratory of Edward D. Churchill at Massachusetts General Hospital for his second surgical research fellowship. He was assisted by his wife, Mary Hopkinson Gibbon. Together, they developed an experimental surgical preparation in cats to remove blood from a vein, supply it with oxygen, and return it to an artery using tubes inserted into the blood vessels. Their objectives were to assemble a device that would keep the blood moving, spread it over a very thin layer to pick up oxygen efficiently and remove carbon dioxide, and avoid both clotting and damaging blood cells.

The Gibbons’ initial attempts included using a vertical revolving cylinder for gas exchange. This device applied centrifugal force to spread the blood over a very thin layer in an oxygen-filled chamber. A piston-type pump was used for blood circulation. Ultimately, they modified this arrangement to use a gentler roller pump that had no valve surfaces. This reduced the damage to blood cells, as well as the surface area available for clot formation. They reported in 1937 that heart and lung function could be artificially maintained for fifty minutes, and the animal’s normal heart function could be restored for a period of several hours. After their return to the University of Pennsylvania School of Medicine in 1935, they repeated their experiments under sterile conditions and reported in 1939 that prolonged survival after heart-lung bypass was possible in animals.

World War II interrupted the progress of Gibbon’s work, but he resumed his research at Jefferson Medical College in 1944. Shortly thereafter, he attracted the interest of Thomas J. Watson, Sr., chairman of the board of International Business Machines (IBM), who provided the services of IBM’s experimental physics laboratory and model machine shop, as well as the assistance of engineers Al Malmrose, Don Rex, Leo Farr, and John Enstrom. IBM constructed and modified two experimental machines during the next seven years, and these engineers contributed significantly to the evolution of a machine that would be practical in humans.

The most critical problem presented by the ambition to take over heart-lung function in humans mechanically was that of achieving the efficiency of gas exchange required to oxygenate such a large flow of blood. This problem was addressed by T. L. Stokes and J. B. Flick, who, while working in Gibbon’s laboratory, observed that turbulence in the blood greatly enhanced gas exchange in the oxygenator. They demonstrated and reported in 1950 that lining the oxygenation cylinder with a wire screen could produce turbulence and the desired oxygenation effect without creating a foam from broken blood cells.

Bernard J. Miller joined Gibbon’s group in January of 1950 and contributed to the final stages in developing the second IBM machine, which was completed in 1951. After testing a series of materials to improve the oxygenation surface, they settled on multiple stainless-steel wire mesh screens suspended in parallel within an oxygen-filled plastic chamber. The screens were coated with a protein solution to permit a complete film to spread over them. The electronic circuit developed to control blood flow through the system was improved, and a filter was incorporated into the circuit to prevent air bubbles or incipient blood clots from reentering the body. Safety systems to maintain power and prevent combustible gases (then used as anesthetics) from entering the system were incorporated into the device, and blood pressure, flow, and hydrogen-ion concentration were continuously monitored in the circuit. By 1952, the survival rate for animals maintained by this device was 90 percent.

Gibbon’s first attempt to use the pump-oxygenator in a human was in a fifteen-month-old baby. This attempt failed, not because of a malfunction or a surgical mistake but because of misdiagnosis. The child died following surgery because the real problem was not corrected by the surgery. On May 6, 1953, the heart-lung machine was first used successfully on a human being, Cecelia Bavolek.

In the six months before surgery, Bavolek was hospitalized three times for symptoms of heart failure when she could not engage in normal activity. With her circulation connected to the heart-lung machine for forty-five minutes, the surgical team headed by Gibbon was able to observe directly and to close an opening between her atria, thereby establishing normal heart function. Two months later, an examination of the defect revealed that it was fully closed, and Bavolek resumed a normal life. Although Gibbon reflected some years later that he may have opened a Pandora’s box, the age of open-heart surgery had begun.

Significance

John Gibbon devoted most of his career to developing the pump-oxygenator, or heart-lung machine. His success depended on a network of critical discoveries made by many others before him, and it combined with concurrent discoveries to make possible future advances, some of which could not even be anticipated by cardiovascular scientists of the time. Heart-lung bypass alone could not make open-heart surgery a truly practical technique. Therefore, once it was possible to keep they body’s tissues alive by diverting blood around the heart and oxygenating it, other questions already under investigation became even more critical. Scientists had yet to determine how to stop and restart the heart, how to evaluate and prevent or correct erratic heartbeats, how to prolong the survival of bloodless organs, how to measure oxygen and carbon dioxide levels in the blood, and how to prolong anesthesia safely during complicated surgery. Thus, following the first successful use of the heart-lung machine, surgeons and engineers continued to refine the methods of open-heart surgery. Many scientists, including those working with Owen Wangenstein at the University of Minnesota and John Webster Kirklin at the Mayo Clinic, employed and improved the technique so consistently in the late 1950’s that by 1960 it was a standard operative procedure.

The immediate result of Gibbon’s invention and its subsequent refinements was the development of reliable surgical techniques to correct congenital heart defects. For example, a hole in the wall between two of the heart’s chambers, such as an atrial septal defect or a ventricular septal defect, could be exposed now to plain view and sewn closed, because blood was diverted around the heart. Valvular stenosis, a stiffening or narrowing of the heart valves, could be relieved with far less risk of permanent damage to the valve because surgeons could now judge the appropriate type and size of correction necessary. Transposed great arteries (that is, misdirected major arteries) could be severed now and rejoined to their appropriate connections with the aid of heart-lung bypass.

Furthermore, the heart-lung apparatus set the stage for the advent of “replacement-parts” solutions for many types of cardiovascular problems. In 1960, Albert Starr and M. L. Edwards first successfully accomplished cardiac valve replacement by placing an artificial ball valve between the left atrium and ventricle. In 1967, R. G. Favaloro performed the first coronary bypass surgery, grafting sections of a leg vein into the heart’s circulation to divert blood around clogged coronary arteries. Likewise, the first successful heart transplant (Christiaan Barnard, 1967) and the controversial Jarvik-7 artificial heart (William DeVries, 1982) required the ability to stop the heart and keep the body’s tissues alive during time-consuming and delicate surgical procedures. While cardiovascular science awaits the developments that will permit the prevention or true cure of the conditions that compromise cardiac functions, these corrective surgical measures, which make use of the heart-lung apparatus, continue to contribute to prolonging life.

Bibliography

Comroe, Jr. Julius H. “The Heart and Lungs.” In Advances in American Medicine: Essays at the Bicentennial, edited by John Z. Bowers and Elizabeth F. Purcell. Vol. 2. New York: Joshua Macy, Jr. Foundation, 1976. An excellently written history of American contributions to the knowledge of cardiovascular and pulmonary function. Puts the significance of Gibbon’s success into context by examining the many scientific discoveries on which it built (including contributions from two important but often uncredited female scientists, Maude Abbott and Helen Taussig) and the many important developments to which it led.

‗‗‗‗‗‗‗. The Retrospectroscope: Insights into Medical Discovery. Menlo Park, Calif.: Von Gehr Press, 1977. Comroe uses a historical perspective to make an insightful and readable examination of the conditions in which important medical discoveries have been made. This work is invaluable to anyone interested in studying the process of science. Included are several references to John and Mary Gibbon, who worked at the University of Pennsylvania when Comroe was an instructor there in pharmacology.

Davis, Goode Edwards, Jr., Edwards Park, and Editors of U.S. News Books. The Heart: The Living Pump. Washington, D.C.: U.S. News Books, 1981. A beautifully illustrated and photographed volume for the general public. Historical, experimental, and clinical aspects of the heart’s function are presented simply and accurately. Treatment and prevention of cardiovascular disease are given ample consideration, as are experimental and clinical techniques. Gibbon’s work is put in perspective with other surgical research of the time. Glossary. Excellent for high school or college students.

Fenster, Julie M. “Long Way to Bypass: John H. Gibbon Jr., the Heart-Lung Machine.” In Mavericks, Miracles, and Medicine: The Pioneers Who Risked Their Lives to Bring Medicine into the Modern Age. New York: Carroll & Graf, 2003. Profile of Gibbon in a companion volume to a documentary series produced on the History Channel detailing advances in medical science. The volume also discusses blood transfusion, kidney transplantation, and the cardiac pacemaker, among many such advances. Bibliographic references and index.

Gibbon, John H., Jr. “The Development of the Heart-Lung Apparatus.” The Review of Surgery 27 (1970): 231-244. John Gibbon’s very readable personal account of his experiences through a career devoted to the development of the heart-lung machine, with a consideration of the problems to be solved in the project and its impact on his life. Includes photographs of the original device and experimental surgery in progress.

Miller, Bernard J. “The Development of Heart-Lung Machines.” Surgery, Gynecology, and Obstetrics 154 (1982): 403-414. Miller’s account of the evolution of heart-lung apparatus from before Gibbon’s era through stages following the first successful use of the apparatus. It is technically complete, especially with respect to modifications made during the stages of development from 1950 to 1954, when Miller was a research associate at Jefferson Medical College.

Moore, Francis D. “Surgery.” In Advances in American Medicine: Essays at the Bicentennial, edited by John Z. Bowers and Elizabeth F. Purcell. Vol. 2. New York: Joshua Macy, Jr. Foundation, 1976. An accessible review of the history of American surgery from colonial times to the present. Moore asserts that two features unique to American surgery after World War II contributed to developments such as Gibbon’s: government support and the availability of animals as experimental models. Includes a photograph of John and Mary Gibbon inspecting the heart-lung machine.