A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery

Abstract

Traditionally, blood flow rates on cardiopulmonary bypass are based primarily on a formula that matches cardiac index to the patient’s body surface area (BSA). However, Ranucci and associates in the Goal-Directed Perfusion Trial (GIFT) trial have shown that coupling the BSA with delivery of oxygen (DO2), known as goal-directed perfusion (GDP), may be a safer approach to determine appropriate blood flows. The objective of this study was to create a GDP reference tool that would allow perfusionists to quickly determine the lowest acceptable blood flow needed to provide a patient of any BSA with a satisfactory DO2 without the need for additional dedicated technology. We approached this problem by deriving a formula for flow (L/min), based on BSA, oxygen content of the blood, and a minimum DO2 of 280 mL·min−1m−2. A quick reference GDP chart was created based on the derived formula, requiring only the patient’s BSA and hemoglobin level to determine a safe minimum flow rate. The proposed tool allows any cardiac surgery center to adopt the GDP technique, even in the absence of instantaneous DO2 monitoring equipment.

Non-invasive and invasive measurement of skeletal muscular oxygenation during isolated limb perfusion

“…Perfusion research has to a great degree been focused on total body oxygen delivery with the aim to determine nadir values for preventing acute kidney injury after cardiac surgery. 8 , 10 – 15 The results from this study however add an overview and certain comprehension of an extremity’s oxygen need, and provide the possibility for goal-directed delivery of sufficient amount of oxygen to the extremity tissue. Our results show that DO 2 is nearly the same for both arms and legs during perfusion.…”

“…Substantial amount of research has been conducted regarding the nadir level of oxygen delivery. In an anesthetized patient (34–36°C) undergoing open heart surgery on cardiopulmonary bypass (CPB), the sufficient amount of DO 2 appears to be 265–300 ml/min/m 2 , 8 , 10 – 17 and a safe upper limit for O 2 ER seems to be 39%. 18 The perfusion flowrate commonly used during cardiac surgery for whole body perfusion is 2.2–2.5 L/min/m 2 , which approximates the patients’ cardiac index based on patient’s body surface area (BSA).…”

“… 15 , 19 A newer form of flowrate setting is goal-directed perfusion, where DO 2 is continuously measured during CPB, with the aim to stay above nadir values of DO 2 through the perfusion. 11 , 13 , 16 , 17 Effective DO 2 during CPB can continuously be monitored by VO 2 and O 2 ER. 20 During ILP only one extremity is perfused, compared to a total body perfusion during open heart surgery, where all vital organs must be optimally perfused.…”

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

“…Ranucci et al [17] also proved that maintaining an iDO 2 ≥ 280 mL/min/m 2 during the CPB reduces CSA-AKI incidence. Srey et al [18] applied the idea of Ranucci and his team but simplified the method. Continuous iDO 2 monitors used by Ranucci are an expensive tool.…”