Oxygen delivery during cardiopulmonary bypass (and renal outcome) using two systems of extracorporeal circulation: a retrospective review

Bennett, Mark J.; Rajakaruna, Cha; Bazerbashi, Samer; Webb, Gerry; Gomez-Cano, Mayam; Lloyd, Clinton

doi:10.1093/icvts/ivt057

Cited by 18 publications

(16 citation statements)

References 19 publications

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“…46 Known intra-operative risk factors for AKI after CPB would be expected to lead to renal hypoxia. These include excessive haemodilution 47 or relatively low pump flow leading to low whole body oxygen delivery, 48,49 and low nadir arterial pressure during CPB. 50 All of these would be expected to reduce renal oxygen delivery.…”

Section: Ischaemia and Hypoxia During And After Cardiopulmonary Bypassmentioning

confidence: 99%

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

et al. 2017

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Acute kidney injury (AKI) is a common complication following cardiac surgery performed on cardiopulmonary bypass (CPB) and has important implications for prognosis. The aetiology of cardiac surgery-associated AKI is complex, but renal hypoxia, particularly in the medulla, is thought to play at least some role. There is strong evidence from studies in experimental animals, clinical observations and computational models that medullary ischaemia and hypoxia occur during CPB. There are no validated methods to monitor or improve renal oxygenation during CPB, and thus possibly decrease the risk of AKI. Attempts to reduce the incidence of AKI by early transfusion to ameliorate intra-operative anaemia, refinement of protocols for cooling and rewarming on bypass, optimization of pump flow and arterial pressure, or the use of pulsatile flow, have not been successful to date. This may in part reflect the complexity of renal oxygenation, which may limit the effectiveness of individual interventions. We propose a multi-disciplinary pathway for translation comprising three components. Firstly, large-animal models of CPB to continuously monitor both whole kidney and regional kidney perfusion and oxygenation. Secondly, computational models to obtain information that can be used to interpret the data and develop rational interventions. Thirdly, clinically feasible non-invasive methods to continuously monitor renal oxygenation in the operating theatre and to identify patients at risk of AKI. In this review, we outline the recent progress on each of these fronts.

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Section: Ischaemia and Hypoxia During And After Cardiopulmonary Bypassmentioning

confidence: 99%

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

et al. 2017

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“…The nadir hematocrit (HCT) on cardiopulmonary bypass (CPB) is widely recognized as a risk factor for postoperative acute kidney injury [ 1 – 4 ], stroke [ 5 , 6 ], and mortality [ 5 ]. The commonly accepted interpretation for this association is that running CPB at a very low HCT value may determine a poor oxygen delivery, leading to end organ dysoxia and consequent organ failure [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia

et al. 2015

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ObjectiveThe nadir hematocrit (HCT) on cardiopulmonary bypass (CPB) is a recognized independent risk factor for major morbidity and mortality in cardiac surgery. The main interpretation is that low levels of HCT on CPB result in a poor oxygen delivery and dysoxia of end organs. Hyperlactatemia (HL) is a marker of dysoxic metabolism, and is associated with bad outcomes in cardiac surgery. This study explores the relationship between nadir HCT on CPB and early postoperative HL.DesignRetrospective study on 3,851 consecutive patients.Measurements and Main ResultsNadir HCT on CPB and other potential confounders were explored for association with blood lactate levels at the arrival in the Intensive Care Unit (ICU), and with the presence of moderate (2.1 – 6.0 mMol/L) or severe (> 6.0 mMol/L) HL. Nadir HCT on CPB demonstrated a significant negative association with blood lactate levels at the arrival in the ICU. After adjustment for the other confounders, the nadir HCT on CPB remained independently associated with moderate (odds ratio 0.96, 95% confidence interval 0.94-0.99) and severe HL (odds ratio 0.91, 95% confidence interval 0.86-0.97). Moderate and severe HL were significantly associated with increased morbidity and mortality.ConclusionsHemodilution on CPB is an independent determinant of HL. This association, more evident for severe HL, strengthens the hypothesis that a poor oxygen delivery on CPB with consequent organ ischemia is the mechanism leading to hemodilution-associated bad outcomes.

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“…Adequacy of flow is an important consideration in the use of miniaturised cardiopulmonary bypass (Mini-CPB) 9 because venous return may be limited during the manipulation of the heart and there is no reservoir to compensate during these periods to maintain target flows. Despite this, in a small, comparative study of cerebral oxygenated haemoglobin concentration and cerebral oxygen saturation during CPB with either Mini-CPB or C-CPB, 10 the authors concluded that both parameters were better maintained by the Mini-CPB system.…”

Section: Introductionmentioning

confidence: 99%

The impact of haemodilution and bypass pump flow on cerebral oxygen desaturation during cardiopulmonary bypass - A comparison of two systems of cardiopulmonary bypass

et al. 2014

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The average indexed bypass pump flow was significantly lower with Mini-CPB. When combined with haemoglobin concentration, the average oxygen delivery was the same between groups. Patients in the C-CPB group had a greater duration and severity of cerebral desaturation to a level <20% below baseline values, but none reached the depth and duration of the cerebral desaturation associated with poor outcome. Cerebral oxygen desaturation with C-CPB was significantly associated with low flows during bypass, whereas desaturation with Mini-CPB was associated with low perioperative haemoglobin concentration.

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Oxygen delivery during cardiopulmonary bypass (and renal outcome) using two systems of extracorporeal circulation: a retrospective review

Cited by 18 publications

References 19 publications

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia

The impact of haemodilution and bypass pump flow on cerebral oxygen desaturation during cardiopulmonary bypass - A comparison of two systems of cardiopulmonary bypass

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