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The Best Science Writing Online 2012
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Editor's Note: We're posting this story from our June 2003 issue because of a new study of the phenomenon.
Key Concepts
- The heart-lung machine, first used on humans in 1953, revolutionized coronary surgery by giving doctors an hour or more to operate on a still heart. Previous techniques allowed only 15 minutes.
- Since the inception of the machine, medicine has recorded cognitive decline inpatients hooked up to it. The condition, later nicknamed “pumphead,” was thought to be short-lived and was often attributed to the general trauma of surgery.
- Recently, long-term studies of patients have shown that pumphead may worsen over time and persist for years. Many factors could be involved, but microscopic cell debris and bubbles generated by the machine are under suspicion.
The last thing I remembered was the cold room with a stainless-steel ceiling. I was about to undergo open-heart surgery, an experience shared by about 500,000 people in the U.S. every year. After the anesthesia took effect, surgeons made an incision in my groin to reach my femoral vein and artery. Through the vein they threaded a tube called a cannula into the right atrium, an upper chamber inside my heart. This tube, and another attached to the artery, was connected to a cardiopulmonary bypass pump, also known as a pump oxygenator or a heart-lung machine. A dose of heparin kept my blood from clotting as it traversed the machine’s innards. As the venous blood passed through the oxygenator, it was cooled to prevent tissue damage. My body temperature lowered to 25 degrees Celsius (77 degrees Fahrenheit)—deep hypothermia. Surgeons inserted an inflatable clamp into my aorta to seal it off. Two liters of cold potassium solution stopped my heart, and for the next two hours the machine took over. An eight-inch incision below my right breast allowed the doctors to pass cameras and instruments between my ribs and then to repair my congenitally defective heart valve.
I left the hospital a week later. The incision healed quickly and painlessly. In a couple weeks I was out and about on slow but successively longer walks. Within a month I was back in the gym. Mentally, however, I felt a bit hazy, a little disconnected and sometimes even lost. I soon learned that the physician’s warning, “You may be a little depressed for a time afterward,” would not do justice to the long, dumbfounding struggle against what seemed to be the sudden onset, at 51 years of age, of attention-deficit disorder or incipient senility. Adrift in a clueless no-man’s-land, I felt my moods range from querulous to despondent. I couldn’t muster the concentration to deal with the problem. I just wanted to be able to think. Think anything.
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30 Comments
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Reply | Report Abuse | Link to thisI am kind of worried about this procedure. I am going to have to have an aortic route surgery.I have an aneurysm at that point. They are going to replace my valve as well. This is great news to hear. Thanks for the informations.
Reply | Report Abuse | Link to thisMy father had double bypass surgery with aortic valve replacement done on March 16 this year. After his surgery, we noticed a difference in his personality immediately. We were told it was due to the extensive surgery. He had some kidney issues, and we were later told again that it was from his kidney levels which can cause confusion. We were also told it was depression from the surgery, and when he got home and in familiar surroundings he would be fine. At times he was his old self, other times distant and staring into space, like he didnt know where he was. If you spoke to him he would answer normally, after a few seconds. On his discharge from the hospital, again I was asking the doctors, are you sure we didnt miss something, he just isnt the same, only to be reassured nothing medically was wrong, all was well and he just needed to get home. Heartbreakingly I tell you, he committed suicide the next day. We were all at our house, and he got up to go to the bathroom(first time going on his own without one of us following him to be sure he was ok ) and took his handgun in with him. All I want to say here is PLEASE watch your loved one after surgery, and avoid the heart lung machine if at all possible. We were never told about the side effects of that machine and Ifeel I want to shout it from the rooftops. Not so that people dont have the surgery, but to just be aware of what can happen mentally to you after this surgery. If we had known exactly what my dad was going through mentally, we could have explained to him what he was feeling so he may have gotten past it. This article is awesome and I hope people pay more attention to this type of thing happening. My dad was never the type to even think of doing something like that, and we were all so shocked and devastated. Since than I have heard of so much of this happening, that I cant believe it. Just be careful and watch over your loved ones after this procedure. There is information online about how to prevent this PUMP HEAD syndrome, by simply warming the body slowly after surgery, please discuss this with your surgeon. Good luck to all of you, just being aware can be so much help, and I sure wish we would have known ahead of time. Thanks for listening!
Reply | Report Abuse | Link to thisHello, Just surfing the web for some information after my husband's open heart surgery at Mayo Clinic in March 2009. He had surgery for a genetic defect. The surgery went very well and we returned home. I am a R.N. and do know of how a patient can get depressed after heart surgery, however, I did not know or were we ever taught about what is called "Pump Head Syndrome". I feel my husband has been depressed and has periods still of depression 6 months post op. He does not think he is depressed and is stubborn to even consider taking any medication for depression. What I am seeing now is I can be talking to him and he looks at me with a scary blank stare. He has memory problems and personality changes as well. I actually thought I was imagining this when my girlfriend who is a R.N. as well observed the same symptoms as I did. My husband has a appointment with his cardiologist this Tuesday afternoon and I will be going to report these symptoms. This is so scary to me to be seeing him like this. I am ever so thankful for the success of his open heart surgery and if we had to do it all over again, he would still have the surgery because there was no other option available for him. But, I wish we were told about this "Pump Syndrome" pre-op and how to deal with it better. I will keep you all informed of his progress and what the cardiologist says on Tuesday. Thank you for this article and the chance to post my information online to share with others.
Reply | Report Abuse | Link to thisMy 63 year old mother recently had aortic valve replacement along with much of the aorta including the root,mytral valve repair and an artery repaired. She was on the pump for nearly 5 hours. Upon waking she became nearly violent and posed a danger to herself, and had to be sedated for several days. She again woke up 7 days later in a very confused state. It's like she is a different person. Her surgery was an emergency procedure, and our family had no time to educate ourselves on what to expect post surgery. After 16 days we brought her home. I am grateful for this life saving procedure. She would have died without it. However, I find it inexcusable that not a single member of the medical staff in all those 16 days even mentioned this condition called "pump-head". Her extreme confusion and personality change was immediately evident to those of us that know her. We asked hospital staff various questions for several days, and were repeatedly reassured that this was simply the effects of anasthesia, and it would soon clear up and she would be fine. I only heard of this condition by searching the internet. The surgery was not an option, there was either the surgery or death, so of course we still would have done it. My point here is that the medical professionals we dealt with seem to be in denial that this condition exists. Let me tell you it is very real and very scary. Families who care for heart surgery patients should be prepared for it so we can help our loved one deal with the frustration and depression that this condition causes. The hospital staff didn't know my mother before her surgery, so could not see as clearly as we did just how extremely affected her mind was. The intelligent, energetic, vibrant mother I knew is gone. In her place is someone more like a frustrated child. I pray daily that this condition will improve and someday I will have the mom I knew back. The medical community needs to recognize this very real condition and include information about it along with all the other information we take home about how to care for the heart surgery patient. Instead they ignore its existence and leave the already worried and worn out family in the dark searching for answers on our own. I don't need scientific studies to prove "pump-head"is real. My family sees its effects in my mom every single day. We should have been informed. I would like to know why we weren't.
Reply | Report Abuse | Link to thisMy husband had a heart attack with subsequent emergency angioplasty surgery to open one artery. He was so confused following this surgery that he had 2 MRI procedures following it to rule out a stroke. Following this he had a triple by-pass that was successful. He came out of this in a very weak and confused state to the point that we have had to place him in an in patent cardiac rehab center. He refuses to eat, can only stand and walk with support and is still very confused. I was visiting my son when all of this happened and he was in surgery before I was able to get to the hospital. I have no idea at this time how long or if he was on the heart-lung machine, but will find out. Before this surgery, he was an active, intelligent individual. I have taught special education for 43 years and he is behaving eerily like many of my learning disabled or TBI students. I can only hope that is is temporary
Reply | Report Abuse | Link to this"pump head" is a very generic term that can be attributed to number of sources, one of which is the heart-lung machine. the body's inflammatory response to the artificial/plastic surface of the heart lung machine, macro and microscopic emboli (particles) of atheroma/plaque dislodged from manipulating the aorta all have the potential to reach the brain and cause minute blockages, the stresses of anesthesia and of surgery all can contribute to a significant post operative confusion/depression in some patients. outcomes and incidence will vary greatly by hospital practices, surgeon's technique, amount & rate of warming/cooling the body, and perhaps greatest by the patient themselves.
Reply | Report Abuse | Link to thisit's unfortunate for anyone who has to experience it. however it is something many professionals are working hard to combat and learn more about.
I was 64 years old when I had open-heart surgery and 7 bypasses on April 9, 2009. As you can imagine, I was on the heart-lung machine for some time - approximately 6 1/2 hours. I have not noticed any significant cognitive decline - other than the "brain farts" or "senior moments" I cursed about before the surgery.
Reply | Report Abuse | Link to thisIn 2007, I wrote and published the book Plaintiff Blues about the depressing job discrimination and retaliation I had experienced as a high school principal - and the litigation that followed. Nothing I have experienced as a result of the open heart surgery or the time on heart-lung machine compares with that level of stress and depression.
However, my emotions seem to be much closer to the surface since the surgery. I find myself tearing up over TV programs or things and thoughts that never would have produced that result in the past. It's no big deal and I can't be certain that it has any relation to the time on the machine.
Other that that, I have not noticed any big difference, except my legs are still bugging me. After 9 months and the full cardiac rehab program, they occasionally swell and require the compression socks.
I was 64 years old when I had open-heart surgery and 7 bypasses on April 9, 2009. As you can imagine, I was on the heart-lung machine for some time - approximately 6 1/2 hours. I have not noticed any significant cognitive decline - other than the "brain farts" or "senior moments" I cursed about before the surgery.
Reply | Report Abuse | Link to thisIn 2007, I wrote and published the book Plaintiff Blues about the depressing job discrimination and retaliation I had experienced as a high school principal - and the litigation that followed. Nothing I have experienced as a result of the open heart surgery or the time on heart-lung machine compares with that level of stress and depression.
However, my emotions seem to be much closer to the surface since the surgery. I find myself tearing up over TV programs or things and thoughts that never would have produced that result in the past. It's no big deal and I can't be certain that it has any relation to the time on the machine.
Other that that, I have not noticed any big difference, except my legs are still bugging me. After 9 months and the full cardiac rehab program, they occasionally swell and require the compression socks.
I have had a double bypass, several baloon jobs, and three stints. I was 47 at the time of the open heart in the summer of 1997. My insurance did not provide for post operative therapy. I had to climb that hill on my own. The depression was massive. I am so glad to here that there are others who experience "PUMP HEAD" . It still lingers here after all this time. My situation was a carreer stopper. am now 100% disabled Inever regained the sharpness and clear focus that once was so important to my success. I knew it was that heart lung machine, I am not crazy. thanks for the info.
Reply | Report Abuse | Link to thisPerhaps I should not be the one explaining this...since it was me who was operated on. I was born with Pulmonic Stenosis. operated on at 13 months old in 1964. On October 15, 2009, (at 46 years old) I had my pulmonary valve replaced. Extremely rare. Heart-lung machine and the scars to prove it. I bled so bad that they had to do exploratory surgery to find out where I was bleeding. I finally woke up 3 days later....they did not expect me to make it. On day 5, I wanted the chest tubes out...but I was still bleeding. I was told I would be depressed, sad, etc. It never happened to me. Released on day 8. was driving at 5 weeks.
Reply | Report Abuse | Link to thisI feel better than ever. Working again after 3.5 months. It is like it has never happened. The cardiothorastic surgeon, family and friends are amazed that I am doing so well. To me, it is like it never happened.
No brain farts, Nothing. I even was shoveling snow today, only 4 months later. No naps, no tiredness....nothing.
My husband received a mechanical aortic valve on 3/2/10. About 2 weeks post-op, I noticed him missing the mark on a couple of conversations. I mentioned it to a couple family members and they too perceived something a bit off about him - a blank look here, a hesitation before answering something there, a wrong response every now and then to something he should have known (like saying our son was in 7th grade when he is almost finished with 9th). I finally called the dr.'s office yesterday afternoon and we are going in. I wish there had been more info provided about this up front - not that we wouldn't have had the surgery, but so that we would have been more prepared and able to respond with efficiency. I am worried about the future because my husband was a genius in his field and I'm seeing a different character in him....
Reply | Report Abuse | Link to thisIt has been 9 yrs since by aortic valve replacement.. i feel at time like an old 386 computer trying to access todays information... accessing, accessing, one moment please...
Reply | Report Abuse | Link to thisdoes not compute... and I think, i use to work for the federal gov. in telecommunications.. very high stress, forced multitasking just to servive..jugle 3-4 phone calls at a time..
today, i try to focus on what day it is..and what bus to catch to see what dr ?? i mention this to my primary dr.. to NO real response..but i am seeing a phsy now and he thought their could be a connection ..pumphead... finally some sort of answer.. between diabetic, kidneys and all the other fun medical stuff i have going on.. i was beginning to WONDER was it ever to get better ?? it looks like in my case at least.. the answer is a FUZZY NO..
November 14 2008 my descending aorta dissected and I had emergency surgery. I was on the pump for more than 5 hours. The first few days afterward I thought I had been kidnapped and that I wasn't in a hospital, I thought people were pretending to be my daughter, it was really my daughter! I experienced dizziness,fogginess and confusion when I tried to make sense of anything. Naturally we thought it was drugs and post-op problems and that I would be getting over it fairly soon.
Reply | Report Abuse | Link to thisWell it has been a year and a half and I still have many problems!
I am extra emotional, I am not very tolerant, I make stupid mistakes, I am clumsy, I am not able to make basic decisions (quickly), I mix up names and time and faces I'm only
52).
I could go on and on! It took me more than an hour just to write this little bit. I will probably write more another time and also respond to some of the other statements on this site.
I am glad to see this site, and I too wish I had been informed of this possibility(it may have made it easier on me emotionally).
I am curious about your age and if you meant your seeing a psychologist or a psychiatrist.
Reply | Report Abuse | Link to thisI am considering seeing a psychiatrist just to rule out post traumatic stress disorder and medicinal depression(among other things).
Also, would you tell me more about how you have been different since the PUMP. Thank you.
Did you expierience any side effects in using your leg and or pain in the leg that was hooked to the lung heart machine? Its been a little over a year and I am still having much difficulty with my R leg and nerve damage.
Reply | Report Abuse | Link to thisI can identify with the author of this article 100%. I too had a valve repair and was on the Heart Lung machine. I am 41 years old and one year out from this surgery and have finally started to feel "normal" again. I healed quite quickly physically but had felt like I was in a day to day fog with attention problems, memory issues and moodiness where I fluctuated between depression and despair on a daily basis. It took months to regain my appetite and any type of regular sleep schedule. This was completely unexpected and never explained to me prior to surgery. It is comforting to hear other people share their accounts of how this feels and how critically it impacts their lives like it has mine. I am thankful for a lifesaving surgery but it has been a looooong road to a full recovery.
Reply | Report Abuse | Link to thisWell, my surgery was on a Thursday morning to repair my Mitral Valve and do a Bypass. My next memory was the following Monday. My wife and kids were unable to wake me or get any response from me for 4 days. Then I began to come around but now it has been 10 months and my confusion is a nightmare. All my family tells me is I am dwelling on it too much and I need to get myself beyond it. There are days I just want to cry for NO reason. I just want someone to understand what I am going through. Thanks to everyone for sharing your experiences. I am so glad to at least know I am not going crazy.
Reply | Report Abuse | Link to thisThough my husband's surgeon does over 90 % of his bypass surgical procedures "off pump" it was not possible for my husband. This also was emergency surgery. He had a heart attack one day, they tried unsuccessfully to do angioplasty the next, so he had a triple bypass on the 3rd day. He is 78 years old and was 78 years young before the surgery. He is very ornery, forgetful and ready to jump down my throat at short notice. We thought that by 3 months he would be back to his old self. With all the doctors' approval, we are on vacation in Europe - next week is 4 months since his heart attack - and he's unable to keep up with me and the other couple we are travelling with. He'd been going to cardiac rehab at the hospital 3 times a week, and he still doesn't have the stamina or strength, Itwould have been helpful for both of us to have known about "Pump Head" - it would have saved several fights and upsets.
Reply | Report Abuse | Link to thisI find the term "pumphead" a bit ambiguous perhaps because I know there are so many facets that can lead to cognitive dysfunctions postoperatively. Despite that some surgeons like to pin these dysfunctions on the "pump" they overlook that in the process of attaching patients to the heart lung machine, they have to poke holes in patients aortas possibly dislodging "emboli" if not then, possibly later as blood flow starts from the heart lung machine. I've seen incidents of surgeons finding "toothpaste" when opening the aorta. Not to mention that anesthesiologists are also responsible for patients oxygenation before and after the takeover of the HL machine. Then there is the time when the surgeon places a clamp across the aorta which could technically dislodge plaque then later removes it when the heart needs to be restarted. I know this article highlights a few causes of cognitive dysfunction but the public needs to be aware that the entire perioperative process has potential processes that could affect postoperative cognition-one could even perhaps label this question as nebulous. I could include blood transfusions, air from IVs, hypotensive episodes, hypoxemia perioperatively, postoperatively in the ICU, etc... and the list goes on. I don't deny that "pumphead" does not exist but to try to pin this as a sole cause is flawed and misleading to the common layman. Off pump bypass as an alternate to on pump heart surgery has also not panned out as the panacea for heart disease treatment. If it had why hasn't it become the standard? Even Pres. Clinton chose to have his surgery done the conventional way. There are so many reasons, unfound causes and effects. Many of which we are barely coming to understand as scientists, clinicians, physicians, etc. What the public needs to understand and remember is that medicine today is driven hard by hard evidence-thus the term "evidenced based medicine." Many of us clinicians today practice this and dismiss antiquated concepts without proof. Patients also have to realize that they are their own worst enemies. Why bother having the complex surgery when you continue to smoke, ignore disease processes like diabetes, not changing hurtful diets or dismissing modest exercise? There is so much to this than meets the eye.
Reply | Report Abuse | Link to thisThe heart lung machine was meant to keep people alive so surgery would be possible. It will never perfectly mimic the job of a healthy heart and human physiology-but so far it works.
Honestly, to me, it doesn't much matter what the cause(s) might have been, I have only the effects with which to be concerned. It's been 4 1/2 years since I had a valve replacement at the age of 47. I am grateful to the people who have chimed in on what has every appearance of being a very real issue. Maybe I would have had these mental difficulties and emotional frustrations had I not even had surgery; however, that would seem a dubious coincidence and would have happened on the more literal side of 'overnight.'
Reply | Report Abuse | Link to thisMy wife, I believe, does not trust that I have real issues, in part because the symptoms are inconsistent. I admit it does add a level of oddity that some days I am more agile with my mental acumen, while other days the dense soup retards my ability to think beyond staring and blinking in the face of stimuli. This is a bit of an exaggeration, but nonetheless there are times when I cannot grasp the simplest concepts, cannot interpret the words of others in real time, and cannot focus on one thing. As a college instructor, this has been a major challenge. I forget names. I lose track of what I am lecturing about. I am unable to draw on data stored in my mind in any time resembling useful. The panic attacks and moments of confusion I tend to try to keep to myself, but they are the bugaboo hiding around any next corner. I have learned to compensate, and fortunately I am bright enough and fleet of thought enough to disguise much of it, but anyone who had seen the lightning fast processing of which my mind was once capable, would be able to detect a difference. I don't meant to appear rude or distant to people, but sometimes I just have a hard time listening and focussing. There are symptoms of so many maladies one can easily find on the Internet. Depression, ADD, borderline personality disorder, etc. All I know is that I still struggle even though my mind has learned some helpful coping and compensating strategies in order to survive in a work environment heavy with the language of professional intellect. But, as Ringo Starr reminds us, 'you know it don't come easy.'
These symptoms of 'pumphead' are the same as for Chronic Fatigue Syndrome, which starts after serious trauma such as Coronary Bypass Surgery or accidents and personal tragedies. There is much research into this field at present. The cause is quite surprising. I am one of the sufferers. Doctor C. Jadin from Belgium and her late Father are the leaders in this field. There are a number of Doctors now in USA, Germany, France and South Africa who have since started her treatments.
Reply | Report Abuse | Link to this020864365156015 CLIENT ACCEPTED
Reply | Report Abuse | Link to thisI had open heart surgery in November, 1957 at age 5 at St Lukes in Cleveland Ohio. This is an interesting article -it makes me wonder about the last 55 years. There are times when I have been depressed, but have come out of those times. I remember being extremely depressed in Kindergarten - but was it because of the surgery or because my mother died the month before my surgery in October, 1957?
Reply | Report Abuse | Link to thisMy father was a mathmatics genius - as is my sister - and I barely made it through high school geometry. I have felt as though my mind, no matter how hard I worked, has had a "cog" missing for advanced mathmatics. Economics, statistics, and basic math have not been problems.
I do have a bachelor's degree with a double major - Sociology and Psychology. I have two Master of Arts degrees - Urban Studies and Divinity. I was finally able to finish my Doctor of Ministry in 2009. All of these degrees require very little math!
I have wondered for years if my surgery had any impact on that advanced mathematical part of my brain. Maybe?
Can someone out there address this?
And yes, for 55 years I have had intermittent foggy times. I brought this up when I was a child to my GP. He did not have an answer. I have simply trained myself to focus, to get out of that 'mode'. I have found that a lot of caffeine helps.
Reply | Report Abuse | Link to thisDepends.....my uncle does not now know the difference, he went in fine and came out nowing very little about anything.
Reply | Report Abuse | Link to thisIts the machine, and the anesthetic if longer than 5-6 hours, cognitive disfunction is the usual outcome, POCD.Doctors need to come to terms with this and confide in patients as to what can occur..there needs to be some new ideas out there to fix a machine that has been the same since the 1950s.
Reply | Report Abuse | Link to thisAYE...you should have been told..its a dark secret since the 1950s and only lately coming to light since more people are effected and the internet making complaints possible around the world.The machine needs serious updating..its not all right just to be kepted alive, it also needs to be a fruitful life as well.
Reply | Report Abuse | Link to thisCognitive dysfunction is very common, POCD with this machine..hard to find help for this, you may bring about a law suit since doctors are still reluctant to speak to family or patients about what can and usually does happen when using the machine..
Reply | Report Abuse | Link to thisIts a shame in this day and age that doctors are reluctant to speak of a very common problem effecting thousands of patients and their families with reguard to the heart machine. Cognitive dysfunction POCD is very common with patients on this machine for heart surgery, patients should be told of the risks. A machine that was a break through in the 1950s, is now of need of a updating.
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