NeonatOx: A Pumpless Extracorporeal Lung Support for Premature Neonates

Abstract

Gas exchange in premature neonates is regularly impaired by structural and functional immaturity of the lung. Mechanical ventilation, which is vitally important to sustain oxygenation and CO(2) elimination, causes, at the same time, mechanical and inflammatory destruction of lung tissue. To date, extracorporeal oxygenation is not a treatment option, one reason among others being the size of available oxygenators and cannulas. We hypothesized that a substantial improvement in gas exchange can be achieved by maintenance of the fetal cardiopulmonary bypass and interposition of a suitable passively driven (arteriovenous) membrane oxygenator. In close cooperation between engineers and neonatologists, we developed a miniaturized oxygenator and adapted cannulas to be used as a pumpless extracorporeal lung support that is connected to the circulation via cannulation of the umbilical cord vessels. First in vitro and in vivo studies show promising results. We regard this as one step on the way to clinical application of the artificial placenta.

A Parallelized Pumpless Artificial Placenta System Significantly Prolonged Survival Time in a Preterm Lamb Model

“…Work to develop such a device started about 50 years ago. Although a blood pump was initially used to circulate the blood (12)(13)(14)(15)(16), more contemporary publications have reported experiments using pumpless systems (17)(18)(19)(20).…”

A paradigm shift in the treatment of extreme prematurity

“…This led to research into the use of a pumpless AV-ECLS system to avoid these issues which have met with limited success. [41-43] Although short term fetal circulation and adequate gas exchange was maintained, our experience with pumpless AV-ECLSrevealed umbilical artery vasospasm, high circuit resistance, and cardiac failure. [42] Two groups recently pursued this type of circuit.…”

“…[42] Two groups recently pursued this type of circuit. Arens et al [43] described the development of the NeonatOx oxygenator with a more than fourfold reduction in size of the oxygenator with good gas exchange properties, and Miura et al [44**] described their experience with a pumpless AV-ECLS circuit which supported a lamb for 18.2h ± 3.2h survival. Both utilized the umbilical vessels, no pump, and a prototype oxygenator with a small priming volume.…”

Une reproduction sans utérus ? État des lieux de l’ectogenèse

“…L'utilisation de nouvelles membranes limitant l'agré gation plaquettaire tout en favorisant un haut niveau d'é changes gazeux a aussi permis d'amé liorer les transferts gazeux [26]. Durant cette pé riode, la PO 2 est resté e normale, la pression arté rielle moyenne a é té maintenue à plus de 35 mmHg, le rythme cardiaque à plus de 140 battements/minute, sans utilisation de vasopresseurs [27]. Durant cette pé riode, la PO 2 est resté e normale, la pression arté rielle moyenne a é té maintenue à plus de 35 mmHg, le rythme cardiaque à plus de 140 battements/minute, sans utilisation de vasopresseurs [27].…”