An extracorporeal artificial placenta supports extremely premature lambs for 1 week

Benjamin Bryner, Brian Gray, Elena Perkins, Ryan Davis, Hayley Hoffman, John Barks, Gabe Owens, Martin Bocks, Alvaro Rojas-Peña, Ronald Hirschl, Robert Bartlett, George Mychaliska*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Purpose: The treatment of extreme prematurity remains an unsolved problem.We developed an artificial placenta (AP) based on extracorporeal life support (ECLS) that simulates the intrauterine environment and provides gas exchange without mechanical ventilation (MV) and compared it to the current standard of neonatal care. Methods: Extremely premature lambs (110-120 days; term=145d) were used. AP lambs (n=9) were cannulated (jugular drainage, umbilical vein reinfusion) for ECLS. Control lambs (n = 7) were intubated, ventilated, given surfactant, and transitioned to high-frequency oscillatory ventilation. All lambs received parenteral nutrition, antibiotics, and steroids. Hemodynamics, blood gases, hemoglobin, and circuit flows were measured. Results: Four premature lambs survived for 1 week on the AP, with one surviving 6 days. Adequate oxygenation and ventilation were provided by the AP. The MV lambs survived 2-8 hours. Each of these lambs experienced a transient improvement with surfactant, but developed progressive hypercapnea and hypoxia despite high airway pressures and HFOV. Conclusions: Extremely premature lambs were supported for 1 week with the AP with hemodynamic stability and adequate gas exchange.Mechanically ventilated lambs succumbedwithin 8 hours. Further studieswill assess control of fetal circulation and organ maturation on the AP.

Original languageEnglish (US)
Pages (from-to)44-49
Number of pages6
JournalJournal of pediatric surgery
Volume50
Issue number1
DOIs
StatePublished - 2015

Keywords

  • Artificial placenta
  • Extracorporeal life support (ECLS)
  • Extracorporeal membrane oxygenation (ECMO)
  • Lung development
  • Prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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