Advances in extracorporeal membrane oxygenator design for artificial placenta technology.

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.

Evaluation of silicon membranes for extracorporeal membrane oxygenation (ECMO).

While extracorporeal membrane oxygenation (ECMO) is a valuable therapy for patients with lung or heart failure, clinical use of ECMO remains limited due to hemocompatibility concerns with pro-coagulatory hollow fiber membrane geometries. Previously, we demonstrated the feasibility of silicon nanopore (SNM) and micropore (SµM) membranes for transport between two liquid-phase compartments in blood-contacting devices. Herein, we investigate various pore sizes of SNM and SµM membranes - alone or with a polydimethylsiloxane (PDMS) protective coating - for parameters that determine suitability for gas exchange. We characterized the bubble or rupture point of these membranes to determine sweep gas pressures at which gas emboli would form. The smallest pore size SNM and the SµM with PDMS coating could be pressurized in excess of 260 cmHg without rupture, which is comparable to hollow fiber sweep gas pressures. Oxygen flux for the SµM with and without PDMS was insignificantly different at 0.0306 ± 0.0028 and 0.0297 ± 0.0012 mL/min, respectively, while SNM flux was significantly lower at 0.0149 ± 0.0040 mL/min. However, the area-normalized mass transfer coefficient of the SNM was 338 ± 54 mL O2 m-2 min-1 cmHg-1 - an order of magnitude higher than that of the SµM with and without PDMS (57.3 ± 5.5 and 55.6 ± 2.2 mL O2 m-2 min-1 cmHg-1). Ultimately, we conclude that SµM-PDMS may make effective membranes for ECMO, since they are both mechanically robust and capable of high oxygen flux.