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The closed loop approach would use a secondary CO2 removal device, such as a bubble oxygenator or membrane lung, to remove CO2 from the dialysate post-dialyzer and drive the bicarbonate concentration back down towards zero.
Such devices have a relatively long history, and by the end of the nineteenth century two different methods of organ perfusion had been developed: von Schröder [1] designed a bubble oxygenator in 1882 while in 1885 von Frey and Grubber [2] developed a rotating disc oxygenator.
Gas exchange was achieved with a bubble oxygenator (Baxter, Utrecht, The Netherlands).
However, the dramatic success of C. Walton Lillehei's cross-circulation technique and Denton Cooley's bubble oxygenator [ 5] led to the rapid expansion of this technology.
Because of the absence of the artificial surfaces of the heart-lung machine, the various platelet activation mechanisms and depletion caused by contact activation with extracorporeal surfaces, bubble oxygenator, cardiotomy suction, and filters are avoided leading to reduced postoperative bleeding [ 26].
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Heart-lung machines have totally disposable tubing and plastic bubble oxygenators.
Oxygenator: there are two types of oxygenator; bubble oxygenators, which are used for perioperative extracorporeal circulation during heart surgery, and membrane oxygenators, which avoid hemolysis associated with bubbling [25, 26].
An artificial heart-lung machine (precharged with crystal) with bubble oxygenators was used to establish the cardiopulmonary bypass.
Membrane oxygenators now have replaced "bubble oxygenators" and have made the long-term use (weeks instead of days) of ECMO possible.
Early ECMO system designs used "bubble oxygenators" that were poorly suited for prolonged use because of their tendency to hemolyze blood.
Oxygenator: there are two types of oxygenator; bubble oxygenators, which are used for perioperative extracorporeal circulation during heart surgery, and membrane oxygenators, which avoid hemolysis associated with bubbling [ 25, 26].
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