The effects of extracorporeal membrane oxygenation on hypoxic fetal lambs

目的：本研究的目的是确定使用静脉动脉或静脉静脉体外膜肺氧合（ECMO）技术，以支持胎儿氧合在utero.Study设计的适用性：ECMO系统与离心泵被施加到15个长期仪表胎羊，范围从125至133天的妊娠，胎盘循环完整。通过插入右心房的12 Fr双腔导管获得血液。氧合后，血液通过颈动脉中的9 Fr.单腔导管（VA ECMO）或右心房中的另一腔（VV ECMO）返回。通过降低母体FiO 2实验性产生胎儿缺氧后，VA ECMO开始维持胎儿氧合30分钟，并切换至VV ECMO。比较两种途径ECMO下胎儿颈动脉和腋动脉的血气变化。同时测定胎鼠血浆心钠素、儿茶酚胺、精氨酸加压素和皮质醇。而且我们 ...更多信息 结果：VA或VV ECMO时双腔导管ECMO血流速度约为50-60 ml/min，降低母体FiO 2可降低胎儿颅颈动脉pO 2。维持VA ECMO或VV ECMO后，pO 2恢复至正常胎儿酸中毒时的水平。胎心率和血压在实验过程中没有显着改变。在VV ECMO过程中，胎鼠血浆儿茶酚胺、AVP和皮质醇水平升高，而胎鼠血浆ANP水平降低。结论：母畜缺氧时，VA或VV ECMO能维持胎儿正常氧合，氧合血应回输至胎儿右心房，以维持胎儿心脏氧合和生理循环。本研究表明，VV ECMO能有效地维持胎儿氧合，对缺氧胎羊的创伤小。少

Objective: The purpose of this study was to determine the applicability of using venoarterial or venovenous extracorporeal membrane oxygenation (ECMO) techniques to support fetal oxygenation in utero.Study Design: An ECMO system with centrifugal pump was applied to fifteen chronically instrumented fetal lambs, ranging from 125 to 133 days of gestation, with the placental circulation intact. Blood was obtained through a 12 Fr. double lumen catheter inserted into the right atrium. After oxygenation the blood was returned through a 9 Fr. single lumen catheter in carotid artery (VA ECMO) or the other lumen in the right atrium (VV ECMO). After fetal hypoxia was experimentally produced by reducing FiO2 of the mother, the VA ECMO started to maintain the fetal oxygenation for 30 minutes, and switched to the VV ECMO. We compared fetal blood gases of cranial carotid and axillar arteries with the both routes of ECMO. We also measured fetal plasma ANP, Catecholamine, AVP and Cortisol. Moreover, we … More determined the distribution of oxygenated blood flow in each period during placental circulation intact by non-radioactive colored microspheres.Results: The ECMO blood flow rate through the double lumen catheter during VA or VV ECMO ranged at approximately 50-60 ml/min. Fetal cranial carotid arterial pO2 was decreased by reducing FiO2 of the mother. After maintaining of VA ECMO or VV ECMO, the pO2 was recovered to the control level under advantaging fetal acidosis. The fetal heart rate and blood pressure were not significantly altered during the experiments. Fetal plasma Catecholamine, AVP and Cortisol increased through the experiments, however fetal plasma ANP decreased during the VV ECMO. The VV ECMO more closely approximated normal intact placental-fetal blood flow distribution than the VA ECMO in fetal lambs.Conclusion: The VA or VV ECMO maintained normal fetal oxygenation during maternal hypoxia The oxygenated blood should be returned to fetal right atrium for maintenance of fetal cardiac oxygenation and fetal physiological circulation. This study indicated that the VV ECMO could maintain fetal oxygenation effectively and less traumatically on hypoxic fetal lambs. Less