Tidal Flow Perfusion for the Artificial Placenta: A Paradigm Shift.
Tidal Flow Perfusion for the Artificial Placenta: A Paradigm Shift.
复制标题
人工胎盘潮汐流灌注：范式转变。
DOI：
10.1097/mat.0000000000001077
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Mychaliska,Geo
中科院分区：
文献类型：
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作者：
Kading,JacquelineC;Langley,MarkW;Lautner,Gergely;Jeakle,MarkMP;Toomasian,JohnM;Fegan,TaylorL;Pfannes,RachelA;Toor,SamanthaC;Reiber,MaryA;Kordell,PeterR;Cornell,MarieS;Bartlett,RobertH;Rojas-Pena,Alvaro;Mychaliska,Geo
在过去的十年中，体外人工胎盘（AP）的血管通路模式经历了许多迭代。我们假设使用潮汐流体外生命（ECLS）支持颈静脉单腔插管（SLC）是一种可行的替代静脉静脉（VV）脐-颈静脉插管和双腔插管（DLC），可以维持胎儿循环，稳定的血流动力学和充足的气体交换24小时。在潮汐流系统体外评估后，6只估计胎龄118-124天（足月145天）的早产羔羊被分娩并接受了VV-ECLS。三个使用DLC支持，三个使用SLC支持，使用潮汐流AP支持。监测血流动力学、循环血流和气体交换。目标胎儿参数：平均动脉压40-60 mmHg，心率140-240次/分钟（bpm）， SatO 2% 60-80%, pao2 25 - 50 mmHg, PaCO 2 30-55 mmHg，供氧> 5 ml o2 /dl/kg/min，回路流量100±25 ml/kg/min。所有动物存活24小时，胎儿循环稳定，血流动力学稳定，气体交换充足。潮汐流组的参数与DLC组具有可比性。利用潮汐流进行单腔颈静脉插管是一种很有前途的血管通路策略。成功的小型化具有巨大的潜力，为临床翻译，以支持极早产儿。
The modalities of vascular access for the extracorporeal artificial placenta (AP) have undergone many iterations over the past decade. We hypothesized that single lumen cannulation (SLC) of the jugular vein using tidal flow extracorporeal life (ECLS) support is a feasible alternative to venovenous (VV) umbilical–jugular cannulation and double lumen cannulation (DLC) and can maintain fetal circulation, stable hemodynamics, and adequate gas exchange for 24 hours. After in vitro evaluation of the tidal flow system, six preterm lambs at estimated gestational age 118–124 days (term 145 days) were delivered and underwent VV-ECLS. Three were supported using DLC and three with SLC utilizing tidal flow AP support. Hemodynamics, circuit flow, and gas exchange were monitored. Target fetal parameters were as follows: mean arterial pressure 40–60 mmHg, heart rate 140–240 beats per minute (bpm), SatO 2% 60–80%, PaO 2 25–50 mmHg, PaCO 2 30–55 mmHg, oxygen delivery> 5 ml O 2/dl/kg/min, and circuit flow 100±25 ml/kg/min. All animals survived 24 hours and maintained fetal circulation with stable hemodynamics and adequate gas exchange. Parameters of the tidal flow group were comparable with those of DLC. Single lumen jugular cannulation using tidal flow is a promising vascular access strategy for AP support. Successful miniaturization holds great potential for clinical translation to support extremely premature infants.