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Sergei S. Brukhonenko designed and constructed one of the earliest heart-lung machines. He was the first to experimentally perform a total body perfusion with the heart of the animal isolated from the circulation. His work paved the way to the first experimental operations on heart valves. Although Brukhoneko's pioneering contributions have not received the recognition they deserve, his work represents an important landmark in cardiac surgery.

Cardiopulmonary bypass with 17 to 57 per cent dilution of hemoglobin for repair of ventricular septal defect (VSD) was applied to 26 infants weighing less than 10 kg at normal temperature. The higher flow rate was required to compensate the reduced oxygen carrying capacity and to maintain an adequate arterial pressure in proportion to a decrease of hemoglobin value. Perfusion index resulted in 3.0 to 6.5 L/m2/min in this series. When the dilution ratio of hemoglobin became more than 50 per cent and high flow rate was required, however, oxygen transfer ratio decreased remarkably on account of inadequate oxygen delivery and imparied venous return. In these cases, it was difficult to remove the diluent immediately after the operation in spite of powerful diuretic therapy. The results of the present study indicate that the safe limits of hemodilution is 50 per cent in cardiopulmonary bypass at normal temperature in infants.

A survey of the present status of extracorporeal circulation in open heart surgery revealed that the pump oxygenator has been widely accepted around the world, and various kinds of heart disease, especially congenital, have been cured surgically with a reasonable degree of safety. The film-type oxygenator, either disc or screen, is the one most commonly used. High flow rate, nearly equivalent to cardiac output in the normal circulation, is considered advantageous in total body perfusion. The combination of hypothermia with the pump oxygenator is still a debatable issue.

Continuous measurement of blood Po2, Pco2, and pH can be made either with intravascular electrodes or with electrodes placed in a flow cuvette. The two methods are reviewed. In this study a system based on the Radiometer flow cuvette was used. The continuous recording was checked at intervals against results obtained by conventional electrode analyses of individual blood samples. The continuous recording and individual checks were virtually identical. Checks on electrode calibration were made after 4–5 hours use, and no significant electrode drift was noted. During perfusion with Rygg-Kyvsgaard bubble-oxygenator, variations in Po2, Pco2 and pH were measured continuously in dogs to register any changes, which might occur in the transition to and from perfusion, and which would be too rapid for measurement by the single sample technique. Apart from catheterization of the venae cavae through the right atrium the heart was undisturbed. In the first minutes of perfusion marked falls in all three parameters wer...

SUMMARY Blood which is spilled into the pericardial cavity is rapidly hemolyzed. The return of this blood to the pump oxygenator is the major source of free plasma hemoglobin in total body perfusion.

Summary A preliminary study of the suspension of animation incorporating a modified model of Neely's indicates that survival may be possible in a reasonable number of experimental animals after a period of 60 min of asanguineous perfusion. Although all measurable parameters of biological activity appear to be considerably reduced, initial studies suggest that some metabolic processes continue, even at markedly reduced temperatures. There is no evident neurological damage in the surviving dog. However, electrocardiography demonstrates changes that may prove to be associated with permanent morphological changes as well. The latter aspect is still under investigation. The potential use of the Neely model for studying complex questions of physiology in the intact organism is tenable, and further exploration of the technique is justified.

A disposable blood oxygenator with built-in temperature controlling element is described. It is made with a semirigid housing of a clear polycarbonate plastic (Lexan). Within the housing is a bubble oxygenating system incorporating within its reservoir a canister providing 270 square inches of temperature exchanging surface.

Acute viral hepatitis complicated by coma carries an extremely poor prognosis. If coma supervenes, it is rare that more than 2o% of patients survive. Exchange transfusions increase the incidence of patients' survival to no more than 35%, and other generally known treatments have less effect. It was found that asanguineous hypothermic total body perfusion (total body wash-out) increased the incidence of the patients' survival to almost 70%. The treatment of acute infectious hepatitis with coma is assisted by the use of total body wash-out. The criteria for patient selection and the optimum timing of the procedure are defined and the method is described in detail.

Six dogs were subjected to asanguineous total body perfusion, hypothermia, and hyperbaric oxygenation for periods up to 2 hrs. After a brief recovery of, vital functions all dogs died. Pancreatitis was a consistent finding at autopsy.

In the period immediately following total body perfusion for open cardiotomy, careful evaluation and management of the patient is required. While physiologic studies carried out during this period are designed principally to give proper direction to the postoperative care of the patient, they may also be used as a measure of the adequacy of perfusion and the functional state of the cardiopulmonary systems. Materials and Methods The data to be presented were obtained during perfusion and in the immediate postoperative period in a group of 10 consecutive patients operated upon for a variety of congenital cardiac defects. One of the patients was mildly cyanotic; the other nine were acyanotic. The patients ranged in age from 1 to 15 years and in weight from 6 to 43 kg. With all patients the Clark oxygenator pump 1 was used. The period of total body perfusion varied from 15½ to 59 minutes. Seven of

Calculations of arterial elastic coefficients of dogs under conditions of total body perfusion have been made by utilizing the pressure data obtained from steady state perfusion and inflow stoppage. This was done by finding the first derivative of the pressure-time curve after inflow stoppage and evaluating this at the starting time of the transient. This "zero" time slope gave the value of the elastic coefficient divided by the resistance at the instant of inflow stoppage, and multiplying this ratio by the resistance evaluated from the immediately preceding steady state conditions gave an estimate of the elastic coefficient, E, of the arterial tree. Drugs were used to alter the resistance, and this permitted an estimate of E under various conditions. The value of E appeared to be a function of arterial pressure, and the value at a pressure of 124 mm Hg was 4,080 dynes/cm5.

A membrane-covered silver-lead fuel cell is desceibed which gives an output voltage proportional to the oxygen partial pressure in the environment to which the membrane is exposed. The device produces a constant output voltage in the temperature range 10° to 40° C when used in conjunction with a temperature compensation circuit. The fuel cell is used to monitor continuously the arterial oxygen partial pressure during whole body perfusion.

To the Editor.— Recently we published an article citing our initial experience with asanguineous hypothermic total body perfusion (total body washout or TBW) in the resuscitation of a patient dying of stage IV hepatic coma. 1 The patient went on to die of Pseudomonas pneumonia which was present prior to the performance of the TBW. That partial success served to teach us to be more selective of future candidates and to make certain adjustments in our perfusate. These were done in our latest attempt to use the procedure in the care of a young airman dying of acute Australia antigen hepatitis. The airman had been ill and hospitalized for four weeks prior to transfer to our hospital. In the fifth week of his illness and in spite of intensive therapy with bowel antisepsis, steroids, and modified diet, he lapsed into a deepening coma. When received at our hospital, the patient

A paracorporeal left ventricular assist device (LVAD) with a capacity to pump 8 L/min of blood was employed in a clinical trial, and this report details the first survivor. A 60-year-old man could not be separated from the pump oxygenator following coronary artery bypass grafting, and, therefore, an LVAD was employed. Almost the entire left ventricular workload was assumed by the mechanical pump so that the myocardium was allowed to rest and recover. The LVAD support was continued for 105 hours. It provided satisfactory total body perfusion with maintenance of good hemodynamics—without serious deleterious effects on hematologic factors. The patient is alive and active without cardiac symptoms 16 months after his operation. The total experience with 13 LVAD implantations warrants continuation of the clinical trials in selected patients. (JAMA243:46-49, 1980)

In a previous study, the survival time of transfused erythrocytes was determined in dogs before and after total body perfusion with a pump oxygenator. 1 In that study, pooled homologous blood taken from the oxygenator and tagged with chromium survived longer in the perfused, thoracotomized dogs than in the control dogs not operated on. Survival time of the homotransfused tagged red blood cells in the perfused animals, however, was still shorter than the survival time in dogs transfused with their own blood. Further experiments in which a dog's own blood was run through the oxygenator without the addition of homologous blood showed that trauma to the erythrocytes in itself specifically accounted for a decrease of approximately 6 days in survival time. There are 2 possible explanations for the relative prolongation of survival time in the perfused dogs. One is that the perfused animal contributed approximately 25% of his own red

There have been several reports on the effectiveness of protamine and hexadimethrine (Polybrene) in neutralizing the effects of heparin. Parkin and Kvale 1 showed in rabbits with no extracorporeal circulation that clotting times returned to normal at a 1.5:1 dose of protamine to heparin in 5 minutes. In 1953, Preston and Parker 2 reported on the effects of hexadimethrine on the clotting time in peptone shock and in experimental radiation injury. They found that in the normal animal 7.5 mg. hexadimethrine neutralized 10 mg. of heparin in vivo. In peptone shock, when the coagulation time was prolonged to 56 minutes or more, hexadimethrine in doses of 0.9 to 2.2 mg. per kilogram restored the coagulation time to approximately control levels within a few minutes. In vitro studies showed that the shortest clotting time occurred when the amount of protamine and heparin exactly neutralized each other. If either was in excess

The majority of unresolved problems in the present era of heart surgery are biologic rather than technical. The advances made in total body perfusion, the improvement in the protection of the myocardium in artificially induced cardiac arrest, etc., have made it possible to deal quite successfully with several types of congenital and acquired heart anomalies. The operative results, however, are still discouraging if the procedure is aimed not only at repair of a defect, but at replacement of a malfunction or destroyed vital structure of the heart, as well. A practical application of this problem is the surgical management of valvular incompetence. Valvular insufficiency can be successfully repaired in some instances by valvuloplasty. In most cases, however, the calcific degeneration of the valve tissue makes plastic correction futile. The only effective way to handle such situations seems to be the complete excision and replacement of the valvular apparatus. Different materials