Novel modification of an artificial placenta: pumpless arteriovenous extracorporeal life support in a premature lamb model
Novel modification of an artificial placenta: pumpless arteriovenous extracorporeal life support in a premature lamb model
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DOI：
10.1038/pr.2012.108
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发表时间：
2012-11-01
影响因子：
3.6
通讯作者：
Hanita, Takushi
中科院分区：
文献类型：
--
作者：
Miura, Yuichiro;Matsuda, Tadashi;Hanita, Takushi
背景：以往旨在开发人工胎盘的研究取得了有限的成功。我们假设在无泵人工胎盘中引入高性能膜氧合器可以延长早产羔羊的存活时间。方法：胎儿娩出后立即插管，将脐带血管与无泵人工胎盘连接。将胎儿和电路都浸泡在温盐水中。结果：5例胎儿附着于人工胎盘后存活18.2 +/- 3.2（平均+/- SEM） h，维持了胎儿循环。循环血流量与平均动脉压正相关，与血乳酸水平负相关。米力农给药会短暂降低乳酸水平，而多巴胺给药会出乎意料地导致乳酸水平显著升高，尽管动脉压升高，循环血流量改善。结论：我们使用高性能的膜式氧合器和小的启动体积延长了胎羊的存活时间。血管收缩剂引起的全身阻力增加，可使循环血流量过度增加，导致全身器官循环衰竭；因此，血管扩张剂可能比血管收缩剂在维持器官血流方面更有用。
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.CONCLUSION: 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.