Post-inoculation Poliomyelitis
Authors: J. Grant
Journal: BMJ (1953)

Oxygen can be introduced into the blood stream by this method, and the extrapulmonary addition is of benefit to dogs made anoxic by a reduction of oxygen in the inspired air.The site of return of artificially arterialized blood is of great importance, and should be either into a central vein or into an artery close to the heart.For these reasons it is felt that the heart-lung machine is now ready for clinical trials in selected cases of extreme cardio-respiratory dysfunction.In those patients in whom derangement of pulmonary function is the chief symptom, it may be advantageous to return the arterialized blood into a central vein, thus greatly simplifying the cannulation and making the surgical intervention a relatively minor one.Though no shunting of blood around the heart would occur in this technique, it is possible that the improved oxygen- ation would reduce the demands on the heart, and second- arily reduce its work.Where the myocardium is primarily involved it is sug- gested that continuous venesection with return of arterialized blood into the arterial circulation will relieve the heart of part of its burden.APPENDIX IThe oxygenator and connecting-blocks were chemically sterilized with "roccal" detergent and 3% formalin, being steeped in the solution for twelve hours.The tubing and cannulae, w.hich we used only once, were autoclaved.After assembly the apparatus was washed with at least 40 litres of sterile distilled water to which had been added enough sodium chloride to provide approximate isotonicity.Fre- quent checks for the presence of formalin provided an indication of the efficiency of the washing process.When two checks were negative the wash-outs were discontinued and the apparatus was charged with donor blood or dex- tran solution.After circulation through the by-pass tube to ensure that no air bubbles remained in the arterial line, the machine was ready for use.XAPPENDIX II1.The arterial and venous blood oxygen were measured by the method of Van Slyke and Neill (1924).2. The red-cell, platelet, leucocyte, differential, and Arneth counts were made, and haematocrit values found by standard methods (Dacie, 1950).3. The plasma haemoglobin was estimated as oxyhaemo- globin on a Spekker absorptiometer modified to accept 1 by 6 in. (2.5 by 15 cm.) test-tube cuvettes.A standard oxyhaemoglobin curve was prepared for each estimation in the following manner: 3-ml.aliquots of plasma were placed in each of five cuvettes; to the first was added 8 ml. of dilute ammonia reagent (5 ml.concentrated NH3 per lire), and this served as a plasma blank; to the remainder was added 0.02, 0.04, 0.06, and 0.08 ml. of whole blood diluted 1 in 2 with normal saline; these were then diluted with 8 ml. of ammonia reagent and read against the plasma blank.3 ml. of plasma obtained from samples taken during the experiment was -similarly treated and compared with the standard curve.4. The plasma sodium and plasma potassium were deter- mined by means of an internal standard flame photometer similar to that described by Berry, Chappell, and Barnes (1946).5. The plasma chloride, plasma C02 combining power, blood sugar, and blood urea were estimated by standard methods (King, 1951).6.The pH was measured by a Muirhead p1-I meter type D-303-b.