Establishment of a national quality improvement process on oxygen delivery index during cardiopulmonary bypass

Targeted oxygen delivery during cardiopulmonary bypass (CPB) has received significant attention due to its influence on patient outcomes, especially in mitigating acute kidney injury. While it has gained popularity in select institutions, there remains a gap in establishing it globally across multiple centers. The purpose of this investigation was to describe the development of a quality improvement process of targeted oxygen delivery during CPB across hospitals throughout the United States. A systematic approach to utilize oxygen delivery index (DO₂i) as a key performance indicator within hospitals serviced by a national provider of perfusion services. The process included a review of the current literature on DO₂i, which yielded a target nadir value (272 mL/min/m²) and an area under the curve (DO₂i²⁷²AUC) cut off of 632. All data is displayed on a dashboard with results categorized across multiple levels from system-wide to individual clinician performance. From January 2020 through December 2022, DO₂i data from 91 hospitals and 11,165 coronary artery bypass graft procedures were collected. During this period the monthly proportion of DO₂i measurements above the target nadir DO₂i²⁷² ranged from 60.5% to 78.4% with a mean+/-SD of 70.8 +/- 4.2%. Binary logistic regression for the first 7 months following monthly DO₂i performance reporting has shown a statistically significant positive linear trend in the probability of achieving the target DO₂i²⁷² (p < .001), with a crude increase of approximately 7.8% for DO₂i²⁷²AUC, and a 73.8% success rate (p < .001). A survey was sent to all individuals measuring oxygen delivery during CPB to assess why a target DO₂i²⁷² could not be reached. The two most common responses were an 'inability to improve CPB flow rates' and 'restrictive allogeneic red blood cell transfusion policies'. This study demonstrates that targeting a minimum level of oxygen delivery can serve as a key performance indicator during CPB using a structured quality improvement process.