J.Jpn. Surg. Soc.. 59(9): 1513-1532, 1958
STUDIES USING THE PUMP-OXYGENATOR FOR OPEN CARDIAC SURGERY IN ANIMAL AND MAN.
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Surgical Department, Tokyo Women's Medical College. (Director: Prof. Shigeru SAKAKIBARA) Keiryo TAKAHASHI |
1. A pump diaphragm type which issues a nearly physiological arterial pulsation during the occlusion of blood supply was contrived. This pump gives almost no mechanical disturbance to blood.
Furthermore, the usual oxygenator was improved and the examination was repeated on the oxygen flow. Thus the safety to life was successfully raised.
2. During the occlusion of blood supply and the extracorporeal circulation the relation of flow and blood pressure to peripheral circulation was examined with a phase contrast microscope. Sometimes motion picture was taken.
As a result it was found that the recovery of the peripheral circulation was delayed when the extracorporeal circulation was apllied after the occlusion of blood supply. However, if it was started simultaneously with or immedeiately before the occlusion and the blood pressure of 60-80 mmHg was maintained, the disturbance of the peripheral circulation was prevented quite effectively.
3. It had been considered that the oxygenation is the most important life-limiting factor in the extracorporeal circulation. However, the author, after animal experiments, arrived a conclusion that other factors than anoxia are more important in the extracorporeal circulation. Consequently, we successfully lengthened the duration of the extracorporeal circulation by decreasing the oxygen flow at the oxygenator to 2 1/min.
4. Regarding the fluctuation of the peripheral hemogram, it appeared that the white cell count after the extracorporeal circulation is an important measure for prognosis : It decreased to below 3,000 in all cases who succumbed. On the other hand, considerable hypoproteinemia was detected in all cases. Therefore, throughout the extracorporeal circulation and even after operation, transfusion of the blood which surpasses the blood loss should be made.
5. On clinical cases the minimum required flow in the extracorporeal circulation was determined. At least 30 cc/kg/min should be given during 20 minute extracorporeal circulation.
By applying clinically the above stated results, a death rate as low as 11.7 per cent in 80 cases was obtained.
(author's abstract)
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