Evolution of membrane oxygenator technology for utilization during pediatric cardiopulmonary bypass

Abstract

The development of the membrane oxygenator for pediatric cardiopulmonary bypass has been an incorporation of ideology and technological advancements with contributions by many investigators throughout the past two centuries. With the pursuit of this technological achievement, the ability to care for mankind in the areas of cardiac surgery has been made possible. Heart disease can affect anyone within the general population, but one such segment that it can affect from inception includes children. Currently, congenital heart defects are the most common birth defects nationally and worldwide. A large meta-analysis study from 1930 to 2010 was conducted in review of published medical literature totaling 114 papers with a study population of 24,091,867 live births, and divulged a staggering incidence of congenital heart disease involving 164,396 subjects with diverse cardiac illnesses. The prevalence of these diseases increased from 0.6 per 1,000 live births from 1930-1934 to 9.1 per 1,000 live births after 1995. These data reveal an emphasis on a growing public health issue regarding congenital heart disease. This discovery displays a need for heightened awareness in the scientific and medical industrial community to accelerate investigative research on emerging cardiovascular devices in an effort to confront congenital anomalies. One such device that has evolved over the past several decades is the pediatric membrane oxygenator. The pediatric membrane oxygenator, in conjunction with the heart lung machine, assists in the repair of most congenital cardiac defects. Numerous children born with congenital heart disease with or without congestive heart failure have experienced improved clinical outcomes in quality of life, survival, and mortality as a result of the inclusion of this technology during their cardiac surgical procedure. The purpose of this review is to report a summary of the published medical and scientific literature related to development of the pediatric membrane oxygenator from its conceptual evolutionary stages to artificially supporting whole body perfusion in the modern pediatric cardiac surgical setting.

Keywords: cardiovascular perfusion; extracorporeal technological advancement; pediatric cardiac surgery.

Figure 1

Early methods to investigate perfusion science.

Figure 2

Historical events, pioneer systems and early oxygenators.

Figure 3

Diagram of the Rashkind oxygenator. Note: Reprinted from The Journal of Pediatrics, 66, Rashkind WJ, Freeman A, Klein D, Toft RW, Evaluation of a disposable plastic, low volume, pumpless oxygenator as a lung substitute, 94–102, Copyright © 1965, with permission from Elsevier.

Figure 4

Chronological order of the advancement of oxygenator technology.

Figure 5

Landé-Edwards (A) and Travenol (B) pediatric membrane oxygenator. Note: Reprinted from The Annals of Thoracic Surgery, Volume 14 (2), Housman LB, Braunwald NS, Experimental evaluation of the Travenol and Landé-Edwards membrane oxygenators for use in neonate perfusions, Pages 150–158, Copyright (1972), with permission from Elsevier.

Figure 6

(A) Variable Prime Cobe Membrane Lung and (B) Shiley Plexus 3.5. Note: Courtesy of Sorin Cardiovascular INC., Arvada, CO, USA.

Figure 7

Quadrox-i neonatal oxygenator displaying integrated arterial line filtration. Note: Courtesy of Maquet Cardiopulmonary AG, Hirrlingen, Germany.