title: Development of an artificial placenta V: 70 h veno-venous extracorporeal life support after ventilatory failure in premature lambs.
abstract: OBJECTIVE
  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: Department of Surgery, University of Michigan, Ann Arbor, MI, USA. briangra@med.umich.edu
authors: Brian W
authors: BW
authors: Gray
authors: Ahmed
authors: A
authors: El-Sabbagh
authors: Sara J
authors: SJ
authors: Zakem
authors: Kelly L
authors: KL
authors: Koch
authors: Alvaro
authors: A
authors: Rojas-Pena
authors: Gabe E
authors: GE
authors: Owens
authors: Martin L
authors: ML
authors: Bocks
authors: Raja
authors: R
authors: Rabah
authors: Robert H
authors: RH
authors: Bartlett
authors: George B
authors: GB
authors: Mychaliska
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001187:Artificial Organs; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D010920:Placenta; D011247:Pregnancy; D047928:Premature Birth; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012138:Respiratory Therapy / Q000295:instrumentation / Q000379:methods*; D012756:Sheep; D013997:Time Factors; D016896:Treatment Outcome