Characterizing Gas Exchange and Assessing Feasibility of a New Lung Assist Device for Pre-Term and Term Neonates with Respiratory Distress Failure

Abstract

<p>Respiratory distress syndrome is a major cause of mortality among pre-term and term neonatal population. To overcome the limitations of current therapies, a new form of respiratory support termed the, “Artificial Placenta” has been proposed. The Artificial Placenta is a type of oxygenator that is attached postnatally via the umbilical vessels to provide pumpless respiratory support to pre-term and term neonates. To develop this concept, our group previously reported on a novel polycarbonate membrane lung assist device (LAD). To build upon its development, the objectives of this thesis are to determine the optimal interface for gas exchange, and characterize the gas exchange properties of the LAD under ambient and oxygen rich atmosphere. Subsequently, its feasibility was determined by studying the effects of extracorporeal flow rates on cardiovascular parameters and gas exchange performance was assessed in a newborn piglet model.</p> <p>In vitro testing demonstrated that PDMS based membrane is the optimal interface for gas exchange in the LAD. In vitro testing of the LAD demonstrated 2.4 µL/min/cm² -3.8 µL/min/cm² and 6.4 µL/min/cm²- 10.1 µL/min/cm² of O₂ and CO₂ transfer respectively under ambient air and oxygen rich atmospheric conditions. Based on these results, the LAD theoretically could provide 6-11% of metabolic O₂ while eliminating 18-26% of CO₂in a newborn healthy pre term infant. Experiments in newborn piglet models achieved pumpless configuration with flow rates up to 60.9ml/kg/min without presenting decompensation. Preliminary, in vivo gas exchange experiments demonstrated O₂ transfer of 3ul/min/cm², which matches closely to in vitro data.</p> <p>A novel pumpless LAD is reported, which provides sufficient respiratory support. High extracorporeal flow rates with stable cardiovascular parameters demonstrate feasibility of the artificial placenta concept. This novel LAD could potentially serve as a rescue device when all other therapies such as nasal continuous positive airway and mechanical ventilation fail.</p>