Document Detail


Development of an artificial placenta V: 70 h veno-venous extracorporeal life support after ventilatory failure in premature lambs.
MedLine Citation:
PMID:  23331807     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: An artificial placenta would change the paradigm of treating extremely premature infants. We hypothesized that using a veno-venous extracorporeal life support (VV-ECLS) artificial placenta after ventilatory failure would stabilize premature lambs and maintain normal fetal physiologic parameters for 70 h.
METHODS: A near-term neonatal lamb model (130 days; term=145) was used. The right jugular vein (drainage) and umbilical vein (reinfusion) were cannulated with 10-12 Fr cannulas. Lambs were then transitioned to an infant ventilator. After respiratory failure, the endotracheal tube was filled with amniotic fluid, and VV-ECLS total artificial placenta support (TAPS) was initiated. Lambs were maintained on TAPS for 70 h.
RESULTS: Six of seven lambs survived for 70 h. Mean ventilation time was 57 ± 22 min. During ventilation, mean MAP was 51 ± 14 mmHg, compared to 44 ± 14 mmHg during TAPS (p=0.001). Mean pH and lactate during ventilation were 7.06 ± 0.15 and 5.7 ± 2.3 mmol/L, compared to 7.33 ± 0.07 and 2.0 ± 1.8 mmol/L during TAPS (p<0.001 for both). pO(2) and pCO(2) remained within normal fetal parameters during TAPS, and mean carotid blood flow was 25 ± 7.5 mL/kg/min. Necropsy showed a patent ductus arteriosus and no intracranial hemorrhage in all animals.
CONCLUSIONS: The artificial placenta stabilized premature lambs after ventilatory failure and maintained fetal circulation, hemodynamic stability, gas exchange, and cerebral perfusion for 70 h.
Authors:
Brian W Gray; Ahmed El-Sabbagh; Sara J Zakem; Kelly L Koch; Alvaro Rojas-Pena; Gabe E Owens; Martin L Bocks; Raja Rabah; Robert H Bartlett; George B Mychaliska
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  48     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-07-05     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  145-53     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Animals, Newborn
Artificial Organs*
Blood Gas Analysis
Disease Models, Animal
Extracorporeal Circulation / instrumentation,  methods*
Female
Hemodynamics
Placenta*
Pregnancy
Premature Birth*
Respiratory Insufficiency / mortality,  therapy*
Respiratory Therapy / instrumentation,  methods*
Sheep
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5 R03 HD062713-02/HD/NICHD NIH HHS; R03 HD062713/HD/NICHD NIH HHS
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