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. 2015 Jan;50(1):44-9.
doi: 10.1016/j.jpedsurg.2014.10.028. Epub 2014 Dec 7.

An extracorporeal artificial placenta supports extremely premature lambs for 1 week

Benjamin Bryner  1 , Brian Gray  1 , Elena Perkins  1 , Ryan Davis  1 , Hayley Hoffman  1 , John Barks  1 , Gabe Owens  1 , Martin Bocks  1 , Alvaro Rojas-Peña  1 , Ronald Hirschl  1 , Robert Bartlett  1 , George Mychaliska  2
Affiliations

An extracorporeal artificial placenta supports extremely premature lambs for 1 week

Benjamin Bryner et al. J Pediatr Surg. 2015 Jan.

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 succumbed within 8 hours. Further studies will assess control of fetal circulation and organ maturation on the AP.

Keywords: Artificial placenta; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Lung development; Prematurity.

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Figures

Figure 1
Figure 1
Experimental setup for mechanical ventilation arm. In the foreground, an extremely premature lamb lies in a modified waterbed. The lamb is intubated and being supported with a high-frequency oscillatory ventilator since conventional ventilation has failed. Monitoring lines and the ventilator circuit are seen above the lamb's head.
Figure 2
Figure 2
Experimental setup for Artificial Placenta support. On the right is an extremely premature lamb which has been intubated but is not being ventilated. The drainage cannula and tubing coming from the jugular vein and the reinfusion cannula and tubing entering the umbilical vein are next to the lamb. The oxygenator is below and to the left of the lamb, and the collapsible-tubing rotary pump is at the bottom of the picture. Blood pressure and heart rate are tracked on the monitor.
Figure 3
Figure 3
Schematic of artificial placenta circuit.
Figure 4
Figure 4
Survival of extremely premature lambs supported by the artificial placenta (AP) or mechanical ventilation (MV). Four of nine lambs survived one week on the AP. Extremely premature lambs could not be ventilated for more than 8h (mean 3.8 ± 2.5 h).
Figure 5
Figure 5
Hemodynamics and gas exchange during support of five extremely premature lambs with an artificial placenta.
Figure 6
Figure 6
Hemodynamics and gas exchange during support of seven premature lambs with mechanical ventilation. The spike in pO2 between hours 1 and 2 is a result of surfactant administration.
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