Heart-lung machine invented
The heart-lung machine, invented by Dr. John Gibbon in the early 1930s, is a groundbreaking device that temporarily takes over the functions of the heart and lungs during surgical procedures. Gibbon's inspiration for developing this machine stemmed from a tragic patient case in 1930, where he realized he could have potentially saved a life if a mechanism existed to oxygenate blood outside the body. Through persistent experimentation and collaboration, Gibbon identified essential components for the machine, including a reservoir, an oxygenator, a heater, and a pump. The innovative use of an anticoagulant, heparin, addressed the critical issue of blood clotting during its circulation through the machine.
By the late 1930s, Gibbon's designs had led to significant advancements in the machine's functionality, improving survival rates in laboratory animals. His work laid the foundation for further enhancements by other researchers and engineers, particularly a fruitful collaboration with IBM in the 1940s that culminated in the Model II heart-lung machine. The first successful use of this model in human surgery occurred in 1953, marking a pivotal moment in medical history that enabled complex cardiovascular procedures to become possible. The heart-lung machine continues to be a vital tool in modern cardiac surgery, significantly impacting patient outcomes and surgical capabilities.
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Heart-lung machine invented
Machine used during surgeries to pump blood while the heart is stopped
Beginning in 1930, John H. Gibbon, Jr., and his wife performed seminal experiments that established and perfected the basic design of the heart-lung machine. They solved several significant problems and established the fundamental model of the heart-lung machine that others improved upon in later decades. In 1953, Gibbon used the heart-lung machine to perform the first open-heart surgery.
On October 3, 1930, Gibbon was assigned to a female patient who eventually died from a blood clot in her pulmonary artery. Gibbon postulated he could have saved her if the oxygen-poor blood from her veins was removed from her body, filled with oxygen and purged of carbon dioxide, and then reintroduced into her arteries. At the time, however, no machine existed that could do such a task. Gibbon determined to design, build, and test a machine that could. He received little encouragement from his colleagues, who tried to dissuade him, but Gibbon pressed forward nevertheless. Such a machine would temporarily substitute for the heart and the lungs, and therefore was called a “heart-lung machine.”
While at Massachusetts General Hospital in Boston, Gibbon surmised that there were four components to a heart-lung machine: a reservoir tank to store blood from the patient’s veins, an “oxygenator” that infused the venous blood with oxygen, a heater to keep the blood warm while outside the body, and a pump to move the blood through the machine and back into the patient’s body. Gibbon, in collaboration with his wife, Mary, designed several experimental heart-lung machines and tested them on cats. Because blood has a marked tendency to clot if it comes into contact with glass, metals, and other surfaces, Gibbon needed to use an anticoagulant to prevent the blood from clotting while in the machine. By mixing the blood with heparin, a chemical that was invented in 1916 but became commercially available during the 1930’s, Gibbon solved the clotting problem.
In 1934, the Gibbons succeeded in blocking blood flow from the heart to the lungs in a laboratory animal on an experimental heart-lung machine without observing any changes in the animal’s blood pressure. However, the lab animals died soon after the procedure. By May, 1935, the Gibbons found that a continuous, pulsating pump, rather than an intermittent pump, allowed lab animals that had been on the machine for more than two hours to recover and survive for several days after the procedure. By 1938, adjustments to the flow rate and better postoperative care strategies boosted to 30 percent the survival rate of laboratory animals that had been on the heart-lung machine for twenty-five minutes.
Impact
Many researchers raced to perfect the heart-lung machine in the decades that followed the 1930’s. However, the Gibbons had already solved the most pressing problems in the design of the heart-lung machine. Their basic design greatly influenced all subsequent machines. Those produced after the 1940’s continued to improve the oxygenator, filters, pumps, and machine-cleaning procedures. Such refinements greatly increased the survival of lab animals that had been placed on the heart-lung machine for up to thirty minutes.
During the 1940’s, Gibbon collaborated with the engineers at IBM Corporation, and their mechanical expertise substantially improved the efficiency of the heart-lung machine. This collaboration produced the Model II heart-lung machine, which solved many major problems, such as low oxygen levels, an inability to properly adjust the flow rate, and blood clots. On May 16, 1953, Gibbon used the Model II heart-lung machine to sustain the life of an eighteen-year-old girl during open-heart surgery while he repaired a septal defect in her heart. This unprecedented medical treatment, which had been unimaginable twenty years before, began with the seminal work conducted by the Gibbons during the 1930’s.
Bibliography
Cohn, Lawrence H. “Fifty Years of Open-Heart Surgery.” Circulation 107 (2003): 2168-2170.
Edmunds, L. H. “Cardiopulmonary Bypass After Fifty Years.” New England Journal of Medicine 351, no. 16 (2004): 1603-1606.
Fou, Adora A. “John H. Gibbon: The First Twenty Years of the Heart-Lung Machine.” Texas Heart Institute Journal 24, no. 1 (1997): 1-8.