The artificial placenta: Continued lung development during extracorporeal support in a preterm lamb model.
PURPOSE
An artificial placenta (AP) utilizing extracorporeal life support (ECLS) could avoid the harm of mechanical ventilation (MV) while allowing the lungs to develop.


METHODS
AP lambs (n = 5) were delivered at 118 days gestational age (GA; term = 145 days) and placed on venovenous ECLS (VV-ECLS) with jugular drainage and umbilical vein reinfusion. Lungs remained fluid-filled. After 10 days, lambs were ventilated. MV control lambs were delivered at 118 ("early MV"; n = 5) or 128 days ("late MV"; n = 5), and ventilated. Compliance and oxygenation index (OI) were calculated. After sacrifice, lungs were procured and H&E-stained slides scored for lung injury. Slides were also immunostained for PDGFR-α and α-actin; alveolar development was quantified by the area fraction of alveolar septal tips staining double-positive for both markers.


RESULTS
Compliance of AP lambs was 2.79 ± 0.81 Cdyn compared to 0.83 ± 0.19 and 3.04 ± 0.99 for early and late MV, respectively. OI in AP lambs was lower than early MV lambs (6.20 ± 2.10 vs. 36.8 ± 16.8) and lung injury lower as well (1.8 ± 1.6 vs. 6.0 ± 1.2). Double-positive area fractions were higher in AP lambs (0.012 ± 0.003) than early (0.003 ± 0.0005) and late (0.004 ± 0.002) MV controls.


CONCLUSIONS
Lung development continues and lungs are protected from injury during AP support relative to mechanical ventilation.


LEVEL OF EVIDENCE
n/a (basic/translational science).
['Church|Joseph T|JT|', 'Coughlin|Megan A|MA|', 'Perkins|Elena M|EM|', 'Hoffman|Hayley R|HR|', 'Barks|John D|JD|', 'Rabah|Raja|R|', 'Bentley|J Kelley|JK|', 'Hershenson|Marc B|MB|', 'Bartlett|Robert H|RH|', 'Mychaliska|George B|GB|']
D000818:Animals D000831:Animals, Newborn D001187:Artificial Organs D004195:Disease Models, Animal D015199:Extracorporeal Membrane Oxygenation D005260:Female D005865:Gestational Age D008168:Lung D010920:Placenta D011247:Pregnancy D047928:Premature Birth D012756:Sheep
Artificial placenta Lung development Extracorporeal life support Prematurity