Reasons a Heart-Lung Machine Is Used

A heart-lung machine is a piece of equipment that temporarily takes over the work of the heart and/or lungs, providing blood and oxygen to the body. Also called a cardiopulmonary bypass machine (CBM) or a heart-lung bypass machine, it is most often used during serious procedures that require the heart to be stopped.

Patients are kept on a heart-lung machine for only as long as it takes to stop the heart from beating, complete open-heart surgery or a procedure on the lungs, and restart the heart.

A heart-lung machine may also be used on a person who needs heart or respiratory support for non-surgical reasons. For example, the machine can be used for someone with heart failure who is waiting for a heart transplant.

What Does a Heart-Lung Machine Do?

To stop the heart without harming the patient, oxygenated blood must continue to circulate through the body during surgery without stopping. The cardiopulmonary bypass pump does the work of the heart, pumping blood through the body and making sure that the tissues of the body get the oxygen they need.

The machine also adds oxygen to the blood while taking over the pumping action of the heart, replacing the function of the lungs.

When a Heart-Lung Machine Is Used

There are two primary reasons why a heart-lung machine is used. The most common use is so the heart can be temporarily stopped for surgery, but the machine can also be used to support people with heart failure.

Heart Surgery

Some cardiac surgeries would be impossible to perform with the heart beating, as surgery would be performed on a “moving target” or there would be significant blood loss.

A great example of this is a heart transplant procedure: The patient's heart must be removed from the body so the donated heart can be put in. Without a pump to replace the action of the heart, the heart transplant would be impossible.

Lung Surgery

The same is true of some lung surgeries; there must be a way to oxygenate the blood when the lungs cannot.

A lung transplant procedure requires an alternative way to oxygenate blood when the lungs cannot, but the heart may continue to beat during the procedure.

Heart Failure

For other patients, the pump is used not for surgery, but to help keep a patient alive when they are experiencing heart failure that would be life-ending. In some rare cases, a heart failure patient may be placed on the pump to support the patient until a heart transplant becomes available. 

How Does a Heart-Lung Bypass Machine Work?

The surgeon attaches special tubing to a large blood vessel (like starting a very large IV) that allows oxygen-depleted blood to leave the body and travel to the bypass machine. There, the machine oxygenates the blood and returns it to the body through the second set of tubing, also attached to the body. The constant pumping of the machine pushes the oxygenated blood through the body, much like the heart does.

The placement of the tubes is determined by the preference of the surgeon. The tubes must be placed away from the surgical site so they do not interfere with the surgeon’s work, but placed in a blood vessel large enough to accommodate the tubing and the pressure of the pump. The two tubes ensure that blood leaves the body before reaching the heart and returns to the body after the heart, giving the surgeon a still and mostly bloodless area to work.

A third tube is also inserted very near or directly into the heart, but not connected to the CPM. It is used to flush the heart with cardioplegia, a potassium solution which stops the heart. Once the cardioplegia takes effect, the CBM is initiated and takes over the heart and lung function.

Who Operates a Cardiopulmonary Bypass Machine?

The person who runs a cardiopulmonary bypass pump is called a perfusionist. Perfusionists typically have a bachelor’s degree in a health-related field, then pursue an additional two years of education training as a perfusionist.

Some perfusionists take an exam to become a certified clinical perfusionist, which is similar to a physician being board certified in a specialty. 

Risks of Cardiopulmonary Bypass

The risks of being on heart and lung bypass include blood clots, bleeding after surgery, surgical injury to the phrenic nerve, acute kidney injury, and decreased lung and/or heart function.

These risks are decreased with shorter times on the pump and increased with longer pump times. 

A Word From Verywell

Any procedure that requires the use of the cardiopulmonary bypass machine is major surgery and should be taken extremely seriously. While the risks associated with these procedures can be significant, these surgeries can also be life-saving or life-enhancing. ​

When possible, it is important to take the time to discuss the risks and rewards of the procedure as well as alternatives to surgery before you make a decision.