Extracorporeal fetal support: A new animal model with preservation of the placenta

Extracorporeal fetal support: A new animal model with preservation of the placenta

Abstract Background Previous models of support for premature sheep fetuses have consisted of cesarean delivery followed by catheterization of umbilical or central vessels and support with extracorporeal membrane oxygenation (ECMO). The limitations of these models have been insufficient blood flow, s...

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Bibliographic Details
Published in:Journal of pediatric surgery Vol. 49; no. 10; pp. 1441 - 1445
Main Authors: Salazar, Jose H, Gabre-Kidan, Alodia, Ortega, Gezzer, Scorpio, Diana, Oldenburg, Gary, Custis, Haven, Ruben, Dawn, Albano, Melanie, Choo, Shelly S, Rhee, Daniel S, Fulton, William B, Wang, Qihong, Papandria, Dominic, Crino, Jude P, Abdullah, Fizan
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-10-2014
Subjects:
Animals
Artificial Organs
Artificial placenta
ECMO
Extracorporeal Membrane Oxygenation
Female
Fetal support
Fetus
Fetus - blood supply
Fetus - physiology
Models, Animal
Organ Preservation - methods
Pediatrics
Placenta - blood supply
Placenta - physiology
Pregnancy
Sheep
Surgery
Uterus - blood supply
Uterus - surgery
ECMO
Sheep
Fetus
Fetal support
Artificial placenta
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Summary:Abstract Background Previous models of support for premature sheep fetuses have consisted of cesarean delivery followed by catheterization of umbilical or central vessels and support with extracorporeal membrane oxygenation (ECMO). The limitations of these models have been insufficient blood flow, significant fetal edema, and hemorrhage related to anticoagulation. Methods We performed a gravid hysterectomy on 13 ewes between 135 and 145 days gestational age. The uterine vessels were cannulated bilaterally and circulatory support was provided via ECMO. Successful transition was defined as maintenance of fetal heart rate for 30 minutes after establishing full extracorporeal support. Circuit flow was titrated to maintain mixed venous oxygen saturation (SvO2 ) of 70–75%. Results Seven experiments were successfully transitioned to ECMO, with an average survival time of 2 hours 9 minutes. The longest recorded time from cannulation to death was 6 hours 14 minutes. By delivering a circuit flow of up to 2120 ml/min, all but one of the transitioned uteri were maintained within the desired SvO2 range. Conclusion We report a novel animal model of fetal ECMO support that preserves the placenta, mitigates the effects of heparin, and allows for increased circuit flow compared to prior techniques. This approach may provide insight into a technique for future studies of fetal physiology.
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ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2014.05.028