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Tidal Flow Perfusion for the Artificial Placenta

A Paradigm Shift

Kading, Jacqueline C.*; Langley, Mark W.*; Lautner, Gergely; Jeakle, Mark M.P.*; Toomasian, John M.*; Fegan, Taylor L.*; Pfannes, Rachel A.*; Toor, Samantha C.*; Reiber, Mary A.*; Kordell, Peter R.; Cornell, Marie S.*; Bartlett, Robert H.*; Rojas-Pena, Alvaro*; Mychaliska, George B.*

doi: 10.1097/MAT.0000000000001077
Original Article: PDF Only
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The modalities of vascular access for the extracorporeal artificial placenta (AP) have undergone many iterations over the past decade. We hypothesized that single lumen jugular cannulation (SLC) 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), SatO2% 60–80%, PaO2 25–50 mmHg, PaCO2 30–55 mmHg, oxygen delivery >5 ml O2/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.

From the *Department of Surgery, ECLS Laboratory, University of Michigan, Ann Arbor, Michigan

LSA Chemistry, University of Michigan, Ann Arbor, Michigan

LSA Physics, University of Michigan, Ann Arbor, Michigan.

Submitted for consideration May 2019; accepted for publication in revised form August 2019.

Disclosure: The authors have no conflicts of interest to report.

The project was funded by National Institutes of Health (NIH 1R01HD073475-01).

Correspondence: George B. Mychaliska, MD, Department of Surgery, ECLS Laboratory, University of Michigan, B560 MSRB II/ SPC 5686, Ann Arbor, MI 48109. Email: mychalis@umich.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs