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Updated: Jun 3, 2025
A Recovery Cardiopulmonary Bypass Model Without Transfusion or Inotropic Agents in Rats
Published on: March 23, 2018
Trial of Oxygen Delivery on Cardiopulmonary Bypass and Major Clinical Outcomes
Rawn Salenger1,2, Clifford E Fonner3, Christa Kampert2
1Department of Surgery, University of Maryland School of Medicine, Towson, Maryland.
Background:
Low oxygen delivery (DO2) on cardiopulmonary bypass has been associated with acute kidney injury. We sought to determine the association of intraoperative DO2, postoperative length of stay, and major postoperative events.
Methods:
DO2 values were calculated in 845 patients after initiation, and every 30 minutes on bypass. Pump flows were increased for DO2 < 280 mL O2/min/m2, but care was not otherwise adjusted. Patients were retrospectively separated into 3 groups based on DO2 values: Group A, all readings ≥280 mL O2/min/m2; Group B, ≥1 reading <280 mL O2/min/m2; Group C, ≥2 readings <280 mL O2/min/m2. Patient outcomes were analyzed.
Results:
We analyzed 845 consecutive adult cardiac cases. Group B patients had a higher Society of Thoracic Surgeons Predicted Risk of Mortality compared with Group A (1.9% vs 1.2%, P < .001), and this effect was amplified for Group C patients (2.2%, P < .001). Postoperative length of stay was lowest for Group A patients (5.2 days) compared with Group B (6.6 days, P < .001) and Group C (7.0 days, P < .001). Overall complications rates were low, although Group A patients experienced lower rates of prolonged ventilation (3.5%) compared with Group B (6.5%, P = .04) and Group C (9.2%, P = .004). Multivariable regression analysis confirmed that DO2 above threshold was associated with significantly reduced rates of prolonged ventilation and postoperative length of stay. Other outcomes were similar between groups.
Conclusions:
Even a single DO2 value below threshold was associated with excess prolonged ventilation and postoperative length of stay, but not other outcomes.
Insights
Maintaining adequate intraoperative oxygen delivery (DO2) during cardiopulmonary bypass is crucial. Even a single low DO2 reading is linked to longer hospital stays and increased ventilation times.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Physiology
Background:
- Low oxygen delivery (DO2) during cardiopulmonary bypass is a known risk factor for acute kidney injury.
- The impact of intraoperative DO2 on postoperative outcomes requires further investigation.
Purpose of the Study:
- To determine the association between intraoperative DO2 levels and postoperative length of stay.
- To investigate the relationship between intraoperative DO2 and major postoperative complications.
Main Methods:
- DO2 values were measured in 845 adult cardiac surgery patients during cardiopulmonary bypass.
- Patients were stratified into three groups based on DO2 readings: consistently adequate (Group A), one low reading (Group B), and multiple low readings (Group C).
- Outcomes including length of stay, mortality risk, and complication rates were analyzed retrospectively.
Main Results:
- Patients with any DO2 reading below the threshold (<280 mL O2/min/m²) had significantly longer postoperative lengths of stay compared to those with consistently adequate DO2.
- Group C patients (multiple low DO2 readings) exhibited a higher Society of Thoracic Surgeons Predicted Risk of Mortality.
- Lower rates of prolonged ventilation were observed in patients with adequate DO2 (Group A) compared to those with low DO2 readings.
Conclusions:
- A single instance of low intraoperative DO2 during cardiopulmonary bypass is associated with increased prolonged ventilation and extended postoperative length of stay.
- Maintaining adequate DO2 is critical for optimizing patient recovery after cardiac surgery.
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