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luck can play in solving a surgical problem. At the time we found we could regulate temperature during heart-lung bypass with a crude heat exchanger, it was close to the Christmas holidays. Ivan Brown's family lived in Lock-port, New York, a town close to the Harrison Radiator Division of General Motors. While visiting his family over the holidays, Ivan met Mr. W. D. Emmons, the Chief Engineer at Harrison. Ivan, who was one of this country's leading authorities on blood banking, seized this unique opportunity. With engineering capability of one and blood handling knowledge of the other, an efficient heat exchanger for a heart-lung machine was planned and then fabricated."^ The instrument consisted of multiple highly polished stainless steel tubes for blood transport, surrounded by a water jacket for circulating water. The heat exchanger had to be extremely efficient to be practical. On an adult at the flow rates of 2500 ml per minute the perfusion was about half that employed for a 70 kg adult today. With high perfusion rates, even a crude heat exchanger will work. With this machine placed in the arterial line, the temperature of the blood was regulated by water circulating in the jacket at a controlled temperature (figure 1). A modification of this instrument is now part of all heart-lung machines, functioning not only to induce and revert hypothermia, but to maintain temperature at normal levels, even to raise it to hyperthermic levels in certain special situations. One problem among the many that we were concerned about was the likelihood of the heart developing ventricular fibrillation when made cold. At that time there were no manufactured devices for correcting this arrhythmia, only locally fabricated paddles plugged directly into the 120 volt lighting system. This anticipated problem with the heart was discussed with Jerome Harris, Duke's Pediatric Cardiologist. On his advice, Glenn Young. Doris Merritt and I worked out a heart stopping (cardioplegic) solution containing potassium, magnesium and prostigmine, that would effectively revert ventricular fibrillation.^- ^ The laboratory studies were completed before we were aware of Mekose's experiments.^ In addition to controlling the arrhythmia, cardioplegia was found to permit cross-clamping of the aorta and thus interrupting the coronary blood flow for a short time, because lack of muscle contraction as well as the hypothermia reduced the metabolic demands of the heart. With this method, an intracardiac operation could be done, in part, in a relatively dry field. With our low flow bubble oxygenator and mild core-induced hypothermia and cardioplegia, a large group of patients was successfully operated upon. This was reported before the Southern Surgical Association,® and marked the first account where these three modalities were deliberately and knowingly combined. Following our success with the use of the heat exchanger to attain mild hypothermia, logically the next step was the extension of the limits to profound hypothermic levels (below 18°C), which we had good reason to believe would increase the safety of the pump oxygenator, allow more BUBBLE TRAP Arterial Line to Patient VENOUS PUMP ARTERIAL PUMP Hot. ^ '^Cold WATER Figure 1. This is a drawing of the extracorporeal system used for core induction for both mild and profound hypothermia. In large individuals, two heat exchangers were placed in series for the latter. In mild and moderate hypothermia, water from the hot and cold water lines was used, passed through a mixing valve. For deep hypothermia, a large bucket of ice water and a small pump were placed on the system. The o.xygenator was fabricated from dairy equipment. The de-huhhler was a Tuffy sponge sprayed with defoaming material. Nearly all currently used oxygenators are modifications of this system, the original DeWall-Lillehei o.xygenator. 796 Vol. 45, No. 12
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1984 |
Identifier | NCHH-17-045 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 45 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-045.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-045 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 796 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1984 |
Identifier | NCHH-17-045-0438 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed45v21984medi_0438.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 45 |
Issue Number | 12 |
Page Number | 796 |
Health Discipline | Medicine |
Full Text | luck can play in solving a surgical problem. At the time we found we could regulate temperature during heart-lung bypass with a crude heat exchanger, it was close to the Christmas holidays. Ivan Brown's family lived in Lock-port, New York, a town close to the Harrison Radiator Division of General Motors. While visiting his family over the holidays, Ivan met Mr. W. D. Emmons, the Chief Engineer at Harrison. Ivan, who was one of this country's leading authorities on blood banking, seized this unique opportunity. With engineering capability of one and blood handling knowledge of the other, an efficient heat exchanger for a heart-lung machine was planned and then fabricated."^ The instrument consisted of multiple highly polished stainless steel tubes for blood transport, surrounded by a water jacket for circulating water. The heat exchanger had to be extremely efficient to be practical. On an adult at the flow rates of 2500 ml per minute the perfusion was about half that employed for a 70 kg adult today. With high perfusion rates, even a crude heat exchanger will work. With this machine placed in the arterial line, the temperature of the blood was regulated by water circulating in the jacket at a controlled temperature (figure 1). A modification of this instrument is now part of all heart-lung machines, functioning not only to induce and revert hypothermia, but to maintain temperature at normal levels, even to raise it to hyperthermic levels in certain special situations. One problem among the many that we were concerned about was the likelihood of the heart developing ventricular fibrillation when made cold. At that time there were no manufactured devices for correcting this arrhythmia, only locally fabricated paddles plugged directly into the 120 volt lighting system. This anticipated problem with the heart was discussed with Jerome Harris, Duke's Pediatric Cardiologist. On his advice, Glenn Young. Doris Merritt and I worked out a heart stopping (cardioplegic) solution containing potassium, magnesium and prostigmine, that would effectively revert ventricular fibrillation.^- ^ The laboratory studies were completed before we were aware of Mekose's experiments.^ In addition to controlling the arrhythmia, cardioplegia was found to permit cross-clamping of the aorta and thus interrupting the coronary blood flow for a short time, because lack of muscle contraction as well as the hypothermia reduced the metabolic demands of the heart. With this method, an intracardiac operation could be done, in part, in a relatively dry field. With our low flow bubble oxygenator and mild core-induced hypothermia and cardioplegia, a large group of patients was successfully operated upon. This was reported before the Southern Surgical Association,® and marked the first account where these three modalities were deliberately and knowingly combined. Following our success with the use of the heat exchanger to attain mild hypothermia, logically the next step was the extension of the limits to profound hypothermic levels (below 18°C), which we had good reason to believe would increase the safety of the pump oxygenator, allow more BUBBLE TRAP Arterial Line to Patient VENOUS PUMP ARTERIAL PUMP Hot. ^ '^Cold WATER Figure 1. This is a drawing of the extracorporeal system used for core induction for both mild and profound hypothermia. In large individuals, two heat exchangers were placed in series for the latter. In mild and moderate hypothermia, water from the hot and cold water lines was used, passed through a mixing valve. For deep hypothermia, a large bucket of ice water and a small pump were placed on the system. The o.xygenator was fabricated from dairy equipment. The de-huhhler was a Tuffy sponge sprayed with defoaming material. Nearly all currently used oxygenators are modifications of this system, the original DeWall-Lillehei o.xygenator. 796 Vol. 45, No. 12 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-045.pdf |
Document Sort | all; nchh-17 |
Article Title | An Account Of How Deep Hypothernnia Was First Used To Increase The Safety Of Open Heart Surgery |
Article Author | Will C. Sealy |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-045 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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