Advances in extracorporeal membrane oxygenator design for artificial placenta technology

Abstract

Extreme prematurity, defined as a gestational age of fewer than 28 weeks, is a significant health problem worldwide. It carries a high burden of mortality and morbidity, in large part due to the immaturity of the lungs at this stage of development. The standard of care for these patients includes support with mechanical ventilation, which exacerbates lung pathology. Extracorporeal life support (ECLS), also called artificial placenta technology when applied to extremely preterm (EPT) infants, offers an intriguing solution. ECLS involves providing gas exchange via an extracorporeal device, thereby doing the work of the lungs and allowing them to develop without being subjected to injurious mechanical ventilation. While ECLS has been successfully used in respiratory failure in full‐term neonates, children, and adults, it has not been applied effectively to the EPT patient population. In this review, we discuss the unique aspects of EPT infants and the challenges of applying ECLS to these patients. In addition, we review recent progress in artificial placenta technology development. We then offer analysis on design considerations for successful engineering of a membrane oxygenator for an artificial placenta circuit. Finally, we examine next‐generation oxygenators that might advance the development of artificial placenta devices.

A Rigid Parallel-Plate Artificial Placenta Oxygenator with a Hemocompatible Blood Flow Path

“…Furthermore, flexible microfluidic devices have yet to make significant progress in the most clinically relevant parameter for an artificial placenta: hemocompatibility. Although attempts have been made to improve hemocompatibility through the use of biomimetic flow paths [24][25][26][27] , microfluidic oxygenators have empirically required very high doses of anticoagulation (typically higher than hollow-fiber membrane oxygenators) to prevent clotting 23 . This finding may be due in part to the combination of their high surface-area-to-volume ratio and non-ideal flow distribution networks.…”

“…Flexible microfluidic oxygenators have been difficult to scale up due to the risk of microchannel collapse when stacking multiple layers into a compact device 22,23 . Along with this, microfluidic oxygenators have featured thicker gas exchange layers, typically around 30 to 70 μm, to improve mechanical robustness, with a tradeoff of decreased efficiency 23 . Furthermore, flexible microfluidic devices have yet to make significant progress in the most clinically relevant parameter for an artificial placenta: hemocompatibility.…”

Extracorporeal cardiopulmonary resuscitation in 2023

“…The oxygenator consists of a semipermeable membrane that allows gas exchange to occur. This core component of the ECMO circuit is responsible for enriching oxygen and reducing carbon dioxide in the patient’s blood [ 19 ]. Last part of the V-A ECMO circuit is the arterial (returning) cannula.…”

Pathogenesis, Prognosis and Outcomes of Multiple Organ Failure in Newborns (Review)

“…Независимым фактором увеличения выживаемости при проведении ЭКМО у новорожденных в критическом состоянии являлось исключение у пациентов внутрижелудочкового кровоизлияния и острой почечной недостаточности [134]. Многообещающие результаты получены при дальнейшем развитии технологии ЭКМО, создании «искусственной плаценты» (технология экстракорпорального жизнеобеспечения -ECLS) для экстремально недоношенных детей (дети с экстремально низкой массой тела), которая сейчас проходит фазу клинических испытаний [135].…”