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Eixarch EAuthorFucho RAuthorHawkins-Villarreal, AmethAuthorSanchez-Martinez, SergioAuthorSánchez-Martínez SAuthorSanin-Ramirez DAuthorCrispi FAuthorBonet-Carne EAuthorGratacos ECorresponding Author

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An Artificial Placenta Experimental System in Sheep: Critical Issues for Successful Transition and Survival up to One Week

Publicated to:Biomedicines. 11 (3): 702- - 2023-03-01 11(3), DOI: 10.3390/biomedicines11030702

Authors: Eixarch, Elisenda; Illa, Miriam; Fucho, Raquel; Rezaei, Kambiz; Hawkins-Villarreal, Ameth; Bobillo-Perez, Sara; Randanne, Paula C; Moran, Miguel; Chorda, Marina; Sanchez-Martinez, Sergio; de Roo-Puente, Yolanda J D; Velilla, Maria del Mar; del Rio, Ruth; Gallego, Marc; Sanin-Ramirez, Daniel; Narvaez, Victor; Crispi, Fatima; Bonet-Carne, Elisenda; Gratacos, Eduard

Affiliations

BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain. - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Barcelona Tech, Universitat Politècnica de Catalunya, Esplugues de Llobregat, 08034 Barcelona, Spain. - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Cardiovascular Surgery Unit, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain. - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Fetal Medicine Service, Obstetrics Department, Hospital "Santo Tomás", University of Panama, Panama City 07127, Panam - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centre for Biomedical Research on Rare Disease - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain. - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Neonatal Unit, Hospital Sant Joan de Déu, University of Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain. - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Esplugues de Llobregat, 08950 Bar - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Pediatric Cardiology Department, Hospital Sant Joan de Déu, University of Barcelona, Esplugues de Llobregat, 08950 Ba - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Perfusion Department, Hospital Clinic, University of Barcelona, Esplugues de Llobregat, 08036 Barcelona, Spain. - Author
BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain.; Translational Computing in Cardiology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Esplugues - Author
Ctr Biomed Res Rare Dis CIBERER, Barcelona 08036, Spain - Author
Hosp Univ Virgen del Rocio, Cardiovasc Surg Unit, Seville 41013, Spain - Author
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona 08036, Spain - Author
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Translat Comp Cardiol, Barcelona 08036, Spain - Author
Inst Recerca St Joan Deu, Barcelona 08950, Spain - Author
Univ Barcelona, Hosp Clin, BCNatal Fetal Med Res Ctr, Barcelona 08028, Spain - Author
Univ Barcelona, Hosp Clin, Perfus Dept, Barcelona 08036, Spain - Author
Univ Barcelona, Hosp St Joan Deu, Barcelona 08028, Spain - Author
Univ Barcelona, Hosp St Joan Deu, Neonatal Unit, Barcelona 08950, Spain - Author
Univ Barcelona, Hosp St Joan Deu, Paediat Intens Care Unit, Barcelona 08950, Spain - Author
Univ Barcelona, Hosp St Joan Deu, Pediat Cardiol Dept, Barcelona 08950, Spain - Author
Univ Panama, Hosp Santo Tomas, Obstet Dept, Fetal Med Serv, Panama City 07127, Panama - Author
Univ Politecn Cataluna, Barcelona Tech, Barcelona 08034, Spain - Author
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Abstract

Objective: To describe the development of an artificial placenta (AP) system in sheep with learning curve and main bottlenecks to allow survival up to one week. Methods: A total of 28 fetal sheep were transferred to an AP system at 110–115 days of gestation. The survival goal in the AP system was increased progressively in three consecutive study groups: 1–3 h (n = 8), 4–24 h (n = 10) and 48–168 h (n = 10). Duration of cannulation procedure, technical complications, pH, lactate, extracorporeal circulation (EC) circuit flows, fetal heart rate, and outcomes across experiments were compared. Results: There was a progressive reduction in cannulation complications (75%, 50% and 0%, p = 0.004), improvement in initial pH (7.20 ± 0.06, 7.31 ± 0.04 and 7.33 ± 0.02, p = 0.161), and increment in the rate of experiments reaching survival goal (25%, 70% and 80%, p = 0.045). In the first two groups, cannulation accidents, air bubbles in the extracorporeal circuit, and thrombotic complications were the most common cause of AP system failure. Conclusions: Achieving a reproducible experimental setting for an AP system is extremely challenging, time- and effort-consuming, and requires a highly multidisciplinary team. As a result of the learning curve, we achieved reproducible transition and survival up to 7 days. Extended survival requires improving instrumentation with custom-designed devices. © 2023 by the authors.

Keywords

Artificial placentaArtificial wombFetal lamb

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Biomedicines due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 85/354, thus managing to position itself as a Q1 (Primer Cuartil), in the category Pharmacology & Pharmacy.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 6.11, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-29, the following number of citations:

  • WoS: 3
  • Scopus: 5
  • Europe PMC: 1

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-29:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 24.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 24 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 8.
  • The number of mentions in news outlets: 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Panama.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Eixarch Roca, Elisenda) and Last Author (Gratacós Solsona, Eduard).

the author responsible for correspondence tasks has been Gratacós Solsona, Eduard.