Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure

Abstract

Introduction: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidity and mortality. This study aims to evaluate the role of low perfusion flow and pressure in the development of cardiopulmonary bypass–associated acute kidney injury, stroke and death, using multicentre registry data. Methods: We identified patients from the Australian and New Zealand Collaborative Perfusion Registry who underwent coronary artery bypass grafting and/or valvular surgery between 2008 and 2018. Primary predictor variables were the length of time the perfusion flow was <1.6 L/min/m2 and the length of time perfusion pressure was < 50mmHg. The primary outcome was new postoperative acute kidney injury defined by the risk-injury-failure-loss-end stage criteria. Secondary outcomes were stroke and in-hospital death. The influence of perfusion flow and pressure during cardiopulmonary bypass on the primary and secondary outcomes was estimated using separate multivariate models. Results: A total of 16,356 patients were included. The mean age was 66 years and 75% were male. Acute kidney injury was observed in 1,844 patients (11%), stroke in 204 (1.3%) and in-hospital death in 286 (1.8%). Neither the duration of the time spent for perfusion flow (<1.6 L/minute/m2) nor the duration of the time spent for perfusion pressure (<50 mmHg) was associated with postoperative acute kidney injury, stroke or death in adjusted models. Conclusions: Neither low perfusion pressure nor low perfusion flow during cardiopulmonary bypass were predictive of postoperative acute kidney injury, stroke or death.

Cardiopulmonary bypass parameters improve the prediction of 30-day mortality following cardiac surgery

“…Given that CPB time was selected in 100% of the bootstrap models, this has a considerable influence on determining the influence of other variables in the final model. This may account for the inconsistency in findings reported by Turner et al who were unable to identify cardiac index <1.6 L/min/m 2 or mean arterial pressure <50 mmHg as predictors of AKI; 25 as CPB duration was treated as a continuous variable the effect of long CPB time may have overestimated the effect of CPB duration in patients with shorter bypass times, thereby influencing the independent effect of the pressure and flow variables.…”

Goal-directed perfusion for reducing acute kidney injury in cardiac surgery: A systematic review and meta-analysis

“…AKI is the most common clinically important complication in adult patients undergoing open-heart surgery with CPB and is associated with increased mortality and morbidity. 2,24 The rate of AKI is related to several factors associated with CPB in cardiac surgery. The components of CPB (pump, oxygenator, suction, and filters) impose mechanical damage to the circulating erythrocytes, leading to intraoperative hemolysis and release of free hemoglobin.…”