Research overview
Currently available ECMO (extracorporeal membranous oxygenation) systems for paediatric and neonatal use employ either roller pumps or centrifugal pumps, and have a comparably large priming volume and high circuit resistance. They are used world-wide to treat babies with respiratory failure.
The use of an external pressure source (external pump) causes haemolysis (rupture of red blood cells) resulting in a sizable increase in the risk of clotting. This in turns necessitates more aggressive anticoagulation therapy which greatly increases the risk of damaging bleeding in the brain. These pumps also fail to mimic the normal triphasic arterial pressure pattern generated by the heart, potentially compromising blood distribution to minor vessels in the peripheral tissues.
Because of this, ECMO is usually limited to preterm babies with a birth weight greater than 2 kg, or an adjusted gestational age of 34 weeks or older. However, with advancements in neonatology and the increasingly higher survival rates of preterm infants born before 34 weeks, the demand to provide this technology to neonates of even younger gestational age without raising associated complications is growing.
This project is targeted specifically at saving the lives and improving the long-term health of preterm babies with cardio-respiratory failure. It will do this by developing a new neonatal ECMO system that is driven by the fetal heart. Such a system will be compatible with smaller (>2kg birth weight, >34 weeks gestational age) and sicker preterm babies that are currently not considered candidates for this life-saving therapy. This pump-free system will also be tested in larger preterm fetuses (i.e. 2.5kg) to explore if its use is advantageous (i.e. less haemolysis, less need for clotting, less risk of brain injury due to bleeding) relative to existing technology.
This research will generate pre-clinical data for an innovative life-support platform tailored for very preterm infants facing cardio-respiratory failure. Additionally, it holds the potential to enhance outcomes for > 34 weeks neonatal were current pump-based technology is used.
Why this project is important
Neonates below 34 weeks’ gestation are at the highest risk of developing cardio-respiratory failure – resulting in organ injury and death. Should ventilation fail, these babies are usually ineligible for the highly invasive live-saving ECMO therapy, due to its high-risk of clotting and catastrophic brain bleeding / injury. This situation creates an urgent clinical need that can only be resolved through the generation a new, safer ECMO technology that does not rely on an external pump.
Project outcomes
This project achieved three key outcomes:
- We successfully completed the proposed studies, which represent the first example (of which we are aware) of pump-free ECMO being used in an experimental model in preterm fetuses weighing less than 2kg.
- We significantly expanded the duration of our proposed treatment period from 5.5 to 48 hours.
- We have generated a large set of highly valuable data that we are now using to prepare a large-scale funding application for studies in even smaller lambs.
This project allowed us to launch an entirely new avenue of research to address a key unmet challenge in neonatology – how to safely and effectively treat preterm infants weighing less than 2kg with respiratory failure.
Project researchers
Dr Haruo Usuda
Professor Matt Kemp
Dr Sean Carter
Partners
Tohoku University, Sendai Japan
Tohoku University Hospital, Sendai Japan
National University of Singapore
The University of Western Australia
Funders
Channel 7 Telethon Trust
Project timeline
2024 – 2025
