Monitoring Oxygen Delivery During Cardiopulmonary Bypass: A Preliminary Multinational Practice Survey.

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Oxygen delivery (DO2) is critical for tissue perfusion during cardiopulmonary bypass (CPB).
• Standardized DO2 monitoring and threshold strategies during CPB lack global consensus.
• Acute kidney injury (AKI) is a significant concern in cardiac surgery patients undergoing CPB.

Purpose of the Study:

• To evaluate global practices in DO2 monitoring during CPB.
• To assess awareness and implementation of goal-directed perfusion (GDP) strategies.
• To identify perceived clinical benefits, including AKI reduction, and barriers to DO2 monitoring.

Main Methods:

• A cross-sectional international survey was conducted.
• 120 participants including perfusionists, anesthesiologists, and cardiac surgeons responded.
• Data on DO2 monitoring methods, target parameters, and GDP practices were collected.

Main Results:

• 73.9% of centers practice goal-directed perfusion (GDP), with higher adoption in high-volume centers.
• Monitoring methods varied: 48.7% used continuous devices, 37.8% intermittent calculations.
• Over 80% maintained DO2 thresholds; hemoglobin targets were 80-90 g/L; cardiac index 2.4-2.6 L/min/m2.
• 55% of GDP users reported reduced AKI incidence.
• Financial constraints and limited resources were key barriers to continuous monitoring.

Conclusions:

• Significant global variability and underuse of DO2 monitoring during CPB were observed.
• Widespread adoption of GDP strategies is limited by cost and resource availability.
• There is an urgent need for international guidelines and standardization of DO2 monitoring during CPB to optimize patient outcomes.