The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study

Coulson, Tim G; McPhilimey, Eve; Falter, Florian; Abu‐Omar, Yasir; Klein, A. A.

doi:10.1053/j.jvca.2019.05.021

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…Pulsatile flow might be expected to provide better microvascular flow, but we found that partially pulsatile flow did not improve renal and intrarenal perfusion or oxygenation during CPB. Our findings are in accord with previous studies of CPB in humans, 34 dogs 35 and pigs 36 that found no significant benefits of pulsatile flow on renal outcomes. In contrast, enhanced renal perfusion, detected using microspheres, has been observed during partially-pulsatile pump flow in piglets 37 and sheep.…”

Section: Discussionsupporting

confidence: 93%

Reversal of renal tissue hypoxia during experimental cardiopulmonary bypass in sheep by increased pump flow and arterial pressure

et al. 2020

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Aim Renal tissue hypoxia during cardiopulmonary bypass could contribute to the pathophysiology of acute kidney injury. We tested whether renal tissue hypoxia can be alleviated during cardiopulmonary bypass by the combined increase in target pump flow and mean arterial pressure. Methods Cardiopulmonary bypass was established in eight instrumented sheep under isoflurane anaesthesia, at a target continuous pump flow of 80 mL·kg−1 min−1 and mean arterial pressure of 65 mmHg. We then tested the effects of simultaneously increasing target pump flow to 104 mL·kg−1 min−1 and mean arterial pressure to 80 mmHg with metaraminol (total dose 0.25‐3.75 mg). We also tested the effects of transitioning from continuous flow to partially pulsatile flow (pulse pressure ~15 mmHg). Results Compared with conscious sheep, at the lower target pump flow and mean arterial pressure, cardiopulmonary bypass was accompanied by reduced renal blood flow (6.8 ± 1.2 to 1.95 ± 0.76 mL·min−1 kg−1) and renal oxygen delivery (0.91 ± 0.18 to 0.24 ± 0.11 mL·O2 min−1 kg−1). There were profound reductions in cortical oxygen tension (PO2) (33 ± 13 to 6 ± 6 mmHg) and medullary PO2 (31 ± 12 to 8 ± 8 mmHg). Increasing target pump flow and mean arterial pressure increased renal blood flow (to 2.6 ± 1.0 mL·min−1 kg−1) and renal oxygen delivery (to 0.32 ± 0.13 mL·O2 min−1kg−1) and returned cortical PO2 to 58 ± 60 mmHg and medullary PO2 to 28 ± 16 mmHg; levels similar to those of conscious sheep. Partially pulsatile pump flow had no significant effects on renal perfusion or oxygenation. Conclusions Renal hypoxia during experimental CPB can be corrected by increasing target pump flow and mean arterial pressure within a clinically feasible range.

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Section: Discussionsupporting

confidence: 93%

Reversal of renal tissue hypoxia during experimental cardiopulmonary bypass in sheep by increased pump flow and arterial pressure

et al. 2020

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“…66 Medications are also under investigation to reduce the perioperative incidence of acute kidney injury, which has a reported incidence between 5% and 42% of cardiac surgery patients depending on risk factors and inter-individual variability. 67 Teprasiran, a small interfering RNA that targets p53, was shown to reduce the incidence, severity, and duration of acute kidney injury in patients undergoing cardiac surgery. 68 The Trial to Evaluate Reduction in Inflammation in Patients with Advanced Chronic Renal Disease Utilizing Antibody Mediated IL-6 Inhibition (RESCUE) trial also found improvement in surrogate markers of inflammation in patients with moderate to severe renal disease for ziltivekimab, an IL-6 inhibitor that reduces inflammation and thrombosis relevant to atherosclerosis.…”

Section: Pharmacological Additions To the Cardiothoracic Tool Boxmentioning

confidence: 99%

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Smoroda

Douin

Morabito

et al. 2022

Semin Cardiothorac Vasc Anesth

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In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: “cardiac anesthesiology and outcomes” (n = 177), “cardiothoracic anesthesiology” (n = 34), “cardiac anesthesia,” and “clinical outcomes” (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

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“…83,84 However, one recently published, relatively large retrospective analysis found no difference in postoperative acute kidney injury [Kidney Disease: Improving Global Outcomes (KDIGO) Criteria] between PF (1266 patients) and NPF (1223 patients) CPB. 85…”

Section: To the Present: Focus On The Microcirculationmentioning

confidence: 99%

Pulsatile versus nonpulsatile blood flow during cardiopulmonary bypass

Chaney

2022

International Anesthesiology Clinics

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The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study

Cited by 15 publications

References 19 publications

Reversal of renal tissue hypoxia during experimental cardiopulmonary bypass in sheep by increased pump flow and arterial pressure

Reversal of renal tissue hypoxia during experimental cardiopulmonary bypass in sheep by increased pump flow and arterial pressure

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Pulsatile versus nonpulsatile blood flow during cardiopulmonary bypass

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