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WoodpeckerRich4461 t1_iv8kksu wrote

The surgeons and anesthesiologist place the patient on a heart-lung bypass device prior to removing the heart. This machine does the work to oxygenate and pump blood through the body during the transplant procedure.

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Fluapaveggen t1_iv8pads wrote

How long is it possible to survive attached to a device like this?

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urzu_seven t1_iv8syug wrote

A heart lung bypass machine used during surgery has a recommended usage limit of 6 hours though it can be used up to 10 hours. The limiting factor is the development of blood clots due to the nature of the machine and how it affects blood.

If a longer period is necessary a different, though similar device called an ECMO ( extracorporeal membrane oxygenation) machine can be used. These can be used for multiple days, with an upper limit around 30. However due to the prolonged use of blood thinners and other issues problems such as excessive bleeding can occur so it’s not ideal.

Finally, short of a living heart transplant there is the artificial heart, which has been able to last up to 5 years in some cases.

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auraseer t1_iv9dfvv wrote

30 days is the usual quoted upper limit of ECMO, but that's an estimate. Some patients can survive much longer on it, into the hundreds of days. There's a published report of one patient who was on ECMO for 605 days, and survived to recover.

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rharvey8090 t1_iv9j1ru wrote

I can assure you that I have personally had several patients on ECMO much longer than 30. Don’t think I’ve ever gotten close to 605 though!

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Thedurtysanchez t1_iv9ygep wrote

Our son was at risk of needing ECMO and the main risk we heard at the time was a poor understanding of the temperature fluctuations in the blood supply could lead to cognitive or behavior complications later in life. Have you experienced that at all?

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rharvey8090 t1_iv9zjll wrote

To be totally honest, I have pretty much zero experience with pediatric ECMO usage, just adults. In our adult patients, we have a controlled temp water bath connected to the circuit for temperature maintenance.

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Thedurtysanchez t1_iva09l4 wrote

I believe they do it for the newborns as well, but the variations may have been enough.

He was on bypass for his surgeries and even that lead the surgeons to let us know he is at higher risk for ADHD for some reason they don't fully understand.

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k9moonmoon t1_ivbgz4y wrote

I wonder if there's a physical causation or if it's just, kids that go through something like that are being closely monitored by parents as they grow and so symptoms for ADHD that might otherwise be overlooked get caught more? How common is an increase in ADHD in similarly expansive interventions in other kids? But bodies are so weird, it being a physical impact that will one day be understood exactly how it works, I'd believe.

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EarthyFeet t1_iv9o4at wrote

Oh we heard a lot about ECMO devices being used in the ICUs during covid for some (I'm assuming) critical cases, and it was a limited resource

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Accomplished_River43 t1_ivavgic wrote

Can that machine be made the size of a heart?

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urzu_seven t1_ivax181 wrote

There are artificial hearts that can be implanted and as i mentioned have a life up to 5 years. Those are also the most complicated and expensive for that reason. You don’t need a HLB machine to be implanted because you are only using it temporarily.

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WoodpeckerRich4461 t1_iv8q105 wrote

In a hospital setting that is equipped with staff and materials to provide proper care, people can survive days or more attached to a device like this on a regular basis for reasons beyond a transplant surgery. Often the survival of a transplant patient comes down to something other than the bypass machine including post-operative complications and immunosuppression

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Taykeyero t1_iv8r9qh wrote

I would offer to this that staying on a bypass isn't optimal. After having a valve repaired I developed migraine. Cardiologist said it happens to patients who stay on them for a long time and my case was long. Others counter this so who knows but I didn't have them before and I still get them. I know, I know..this doesn't prove anything but I'm sharing anyway.

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Practice_NO_with_me t1_iv95rko wrote

Isn't there a guy who has survived 100+ days on a portable heart machine? It's like a backpack he carried everywhere.

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Brendan87 t1_iv98v3w wrote

You’re thinking of the movie Crank 2 starring Jason Statham. Hope this helps!

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TheGatsbyComplex t1_iv98gja wrote

That is not quite the same. Cardiopulmonary bypass is for patients whose hearts and lungs don’t work… they are 100% comatose.

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southbysoutheast94 t1_iv9zqi5 wrote

Not necessarily while being “on pump” typically is during GA, on ECMO no sedation is inherently needed.

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futurettt t1_ivb6ymb wrote

My perfusionist friends would be happy you upgraded them to surgeons and anesthesiologists!

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WoodpeckerRich4461 t1_ivclqfr wrote

My apologies 😅 I didn’t mean to leave out critical team members. We absolutely couldn’t perform these operations without the help of our perfusionist colleagues, nursing staff and others who help with the case.

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Pyr0Duck t1_iv93nks wrote

Just to add to what has already been said, I actually got to meet Dr. Russell Nelson (one of the inventors of the first successful heart and lung machine) and he mentioned that one of the issues was getting the heart to stop in a way that could be restarted later after they did repairs on the heart. So, he and his team figured out that you could hook up the patient to the machine and then inject the heart with a solution of potassium chloride to stop the heart. Once the heart stops, they turned on the machine and then did repairs on the stopped heart. Once the repairs had been done, they turned off the heart and lung machine and then quickly injected the heart with a solution of sodium chloride to get the repaired heart to start up again.

Just as an interesting side fact about Dr. Nelson, he told me that he got the idea on how to stop the heart and then restart it from reading the scriptures.

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caspy7 t1_iv98xn7 wrote

Did he mention which scriptures?

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Pyr0Duck t1_ivafoih wrote

Yes, he did. But I can't remember the specific verses. It was actually an interesting story though. He said that when he was in medical school, it was taught that open heart surgery was impossible because the heart would stop as soon as it was touched. However, as he started his medical career, they discovered in animals that the heart could continue beating even if it was touched. So, as he was thinking about this, he was reading the scriptures and came across a scripture that essentially said that everything in the world is given a law and that even the plants and animals must abide by these laws. After reading that, he said that he felt impressed that if everything has a law, then the beating heart must also follow some laws or "rules". So, he began researching how muscles know when to contract, etc. and found that too much potassium tells the muscle to stop. However, once the potassium levels dropped, the muscle would start again. He said he had this sudden thought that that was the "law given to the heart" and so he started trying out this method. It ended up working really well and was key to making the heart and lung machine work in practice.

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orein123 t1_iv8lc4e wrote

The only thing the heart does to keep the body alive is circulate blood. If you hook soneone up to a machine that keeps their blood pumping, then they don't really need their heart, at least for a time. With modern technology, infection and overall practicality of moving around with such a machine make doing so ineffective in the long run, but it works plenty long enough for surgery.

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Taykeyero t1_iv8s0li wrote

And there's no bypass machine small enough to tote around. These things, fully configured are like 48x36x70 inches and weigh a couple hundred lbs and require electric power. They also require an oxygen feed as they not only circulate but oxygenate your blood. They also require a trained specialist to operate..known as a perfusionist. They are called heart/lung bypass machines. I know this from having heart surgery but also because I am a medical planner and have done several cardiac surgery suites.

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yournakeddad t1_ivbxlrm wrote

Some people waiting for a new heart or who aren’t candidates for heart transplant get something called an LVAD (left ventricular assist device). The device is implanted in their heart and they carry the control system and batteries around with them in a backpack and it pushes the blood through their body! You can live for a decade or more with this thing!

These people don’t have a pulse because the flow is continuous. It’s a little unsettling when you try to feel for one.

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Tools4toys t1_ivc4u9l wrote

My SO worked at a school where there was a student who attended school for 6 months with a LVAD device. As described it was a backpack powered device and the student was able to attend school normally. My SO was an employee at the school and was trained to be able to provide assistance if needed to the student. The student later received a heart transplant and no longer needed the LVAD device. Unfortunately they died approximately 5-6 years after the transplant.

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harkhinz OP t1_iva4kwa wrote

Wow, I'm ignorant of a lot of things in medicine, I used to think that once the heart stops, the body goes dead.

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orein123 t1_ivbd6l9 wrote

Gets even better when we acknowledge the fact that our medical definition of "dead" is very convoluted. Dying isn't something that happens all at once, so pinpointing the exact moment someone dies is a bit tricky.

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fishmakegoodpets t1_iva7frf wrote

Technically, yes. When the heart stops beating a person is “dead”. CPR is performed on technically dead patients.

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Darkranger23 t1_ivb9tdw wrote

That's not true at all. CPR is performed in the field on non-responsive patients who aren't breathing. Depending on level of training, you may or may not bother looking for a pulse.

In hospitals, CPR will be performed when the heart stops moving blood effectively. There are several ineffective rhythms the heart may be in. None of which would classify the patient as dead.

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[deleted] t1_ivbh994 wrote

[removed]

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Doormatty t1_ivbtarl wrote

Breathing does nothing without a working heart to pump the oxygenated blood around the body.

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