title: An extracorporeal artificial placenta supports extremely premature lambs for 1 week.
abstract: OBJECTIVE
  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.
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bryner
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Gray
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Perkins
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Davis
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Hayley
authors.initials: H
authors.lastname: Hoffman
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John
authors.initials: J
authors.lastname: Barks
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Gabe
authors.initials: G
authors.lastname: Owens
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Bocks
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rojas-Peña
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Hirschl
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bartlett
authors.affiliation: Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: mychalis@med.umich.edu.
authors.forename: George
authors.initials: G
authors.lastname: Mychaliska
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001187:Artificial Organs; D001784:Blood Gas Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000503:physiopathology / Q000628:therapy*; D010920:Placenta; D011247:Pregnancy; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012756:Sheep
chemical_list: D011663:Pulmonary Surfactants
keywords: Artificial placenta; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Lung development; Prematurity