title: Novel modification of an artificial placenta: pumpless arteriovenous extracorporeal life support in a premature lamb model.
abstract: BACKGROUND
  Previous studies aimed at developing an artificial placenta have had limited success. We hypothesized that the introduction of a high-performance membranous oxygenator to a pumpless artificial placenta could prolong the survival time of premature lambs.
  
  
  METHODS
  Immediately after delivery of the fetuses, the umbilical vessels were cannulated and connected to the pumpless artificial placenta. Both the fetuses and the circuit were submerged in a warm saline bath.
  
  
  RESULTS
  Five fetuses survived for 18.2 ± 3.2 (mean ± SEM) h after attachment to the artificial placenta, which maintained fetal circulation. Circuit blood flow was positively correlated with mean arterial pressure and negatively correlated with blood lactate levels. Milrinone administration transiently decreased lactate levels, although dopamine administration unexpectedly induced a marked increase in the lactate levels despite an elevated arterial pressure and improved circuit blood flow.
  
  
  CONCLUSIONS
  We prolonged the survival of fetal lambs using a high-performance membranous oxygenator with a small priming volume. The increased systemic resistance induced by vasoconstrictors may increase the circuit blood flow excessively, resulting in circulation failure in systemic organs; therefore, vasodilators may be more useful than vasoconstrictors for maintaining organ blood flow within this circuit.
authors.affiliation: Center for Perinatal and Neonatal Care, Tohoku University Hospital, Sendai, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Miura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Akio
authors.initials: A
authors.lastname: Funakubo
authors.forename: Shinpei
authors.initials: S
authors.lastname: Watanabe
authors.forename: Ryuta
authors.initials: R
authors.lastname: Kitanishi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Saito
authors.forename: Takushi
authors.initials: T
authors.lastname: Hanita
mesh_terms: D000818:Animals; D062186:Arterial Pressure; D001187:Artificial Organs; D004195:Disease Models, Animal; D004298:Dopamine / Q000008:administration & dosage; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D005865:Gestational Age; D019344:Lactic Acid / Q000097:blood; D020105:Milrinone / Q000008:administration & dosage; D010920:Placenta; D021041:Placental Circulation / Q000187:drug effects; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D012756:Sheep; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D019344:Lactic Acid; D020105:Milrinone; D004298:Dopamine