Technical feasibility of umbilical cannulation in midgestation lambs supported by the EXTra-uterine Environment for Neonatal Development (EXTEND).

Autor: Hornick MA; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Mejaddam AY; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., McGovern PE; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Hwang G; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Han J; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Peranteau WH; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Partridge EA; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Davey MG; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania., Flake AW; Center for Fetal Research, Department of Surgery, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2019 Dec; Vol. 43 (12), pp. 1154-1161. Date of Electronic Publication: 2019 Jul 28.
DOI: 10.1111/aor.13524
Abstrakt: EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system for supporting extremely premature infants that replicates in utero conditions by maintaining a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit connected to the umbilical vessels. Target gestational age (GA) for EXTEND support in human infants is 23-27 weeks, when immature lungs are most susceptible to injury in the setting of air ventilation. We previously demonstrated physiologic support of premature lambs cannulated at 105-117 days GA (lungs developmentally analogous to the 23-27 week GA human infant) for up to 28 days on EXTEND. In the present study, we sought to determine the technical feasibility of umbilical vessel cannulation in 85-96 days GA lambs delivered to EXTEND at weights equivalent to the 23-27 week GA human infant (500-850 g). Five preterm lambs were cannulated at 85-96 days GA (term 145 days) and supported on EXTEND for 4-7 days. All lambs underwent umbilical artery and umbilical vein cannulation. Circuit flows and pressures were monitored continuously, and blood gases were obtained at regular intervals for assessment of oxygen parameters. Systemic pH and lactate were measured at least once daily. Mean body weight at cannulation was 641 ± 71 g (range 480-850 g). All lambs were cannulated successfully (cannula size varied from 8 to 12 Fr), and mean survival on EXTEND was 140 ± 7 hours. Mean circuit flow was 213 ± 15 mL/kg*min, mean pH was 7.37 ± 0.01, and mean lactate was 1.6 ± 0.2 mmol/L. During the initial 120 hours after EXTEND cannulation, there were no significant differences between 85-96 days GA lambs and 105-117 days GA lambs in weight-adjusted circuit flows, oxygen delivery, pH, or lactate levels. This study demonstrates successful umbilical cord cannulation and adequate circuit flows and oxygen delivery in midgestation lambs size-matched to the 23-27 week GA human fetus, which represents an important step in the translation of EXTEND to clinical practice.
(© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)
Databáze: MEDLINE
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