International Perfusion Association

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Category: CPB

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Plasma Hyperosmolality as a Risk Factor for Postoperative Acute Kidney Injury in Cardiopulmonary Bypass Patients

This double-blind, randomized controlled trial from a tertiary teaching hospital in Sweden aimed to evaluate the impact of hyperosmolar priming solutions on cardiac surgery-associated acute kidney injury (CSA-AKI). Including patients aged ≥65 years undergoing routine cardiac surgery with cardiopulmonary bypass, the study compared the effects of a Ringer’s acetate based solution with Mannitol and sodium concentrate to a control group. Results indicated that while the hyperosmolar prime solution itself did not increase postoperative CSA-AKI incidence, high plasma osmolality was identified as an independent risk factor, increasing CSA-AKI risk by 30%. The findings underscore the need for further investigation into plasma hyperosmolality’s role in CSA-AKI risk.

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March 25, 2024
Pig CPB

Cerebral Perfusion and Metabolism with Mild Hypercapnia vs. Normocapnia in Porcine Models Post Cardiac Arrest: Impacts of Targeted Temperature Management

This study evaluates the effects of mild hypercapnia compared to normocapnia on cerebral blood flow and metabolism in porcine models post-cardiac arrest, with and without targeted temperature management (TTM33). It involved resuscitating 39 pigs after 10 minutes of cardiac arrest and randomizing them to different conditions. Results indicate that hypercapnia increases cerebral flow in all groups, but raises intracranial pressure and lowers cerebral perfusion pressure in non-TTM animals. Hypercapnia with TTM33 showed reduced cerebral lactate, pyruvate, glycerol, and lactate/pyruvate ratios, highlighting the varying impacts of hypercapnia with TTM.

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March 22, 2024
Vasopressin

Prospective Randomized Double-Blind Study to Evaluate the Superiority of Vasopressin Versus Norepinephrine in the Management of Patients at Renal Risk Undergoing Cardiac Surgery with Cardiopulmonary Bypass (NOVACC Trial)

The NOVACC trial, a multicentre, randomized, double-blind study, evaluates vasopressin against norepinephrine for patients at renal risk during cardiac surgery with cardiopulmonary bypass. Targeting the reduction of cardiac surgery-associated acute kidney injury (CS-AKI) and its associated morbidity and healthcare costs, the study is based on preliminary findings suggesting vasopressin’s potential to lower CS-AKI incidence and post-operative atrial fibrillation. With the primary endpoint being the occurrence of acute kidney injury and death, and secondary endpoints including a range of post-operative complications and medico-economic costs, the trial aims to demonstrate vasopressin’s effectiveness in reducing CS-AKI, mortality, and medical expenses.

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March 20, 2024
MAP Study

Mean Arterial Pressure (MAP) Trial: Study Protocol for a Multicentre, Randomized, Controlled Trial to Compare Three Different Strategies of Mean Arterial Pressure Management during Cardiopulmonary Bypass

The MAP Trial is a pioneering multicentre, randomized, controlled study comparing three strategies for managing mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) in heart surgery. It challenges the traditional “standard MAP” of 50-60 mmHg by introducing a “high MAP” (70-80 mmHg) and a “patient-tailored MAP” approach, aiming to optimize organ perfusion. The study’s primary goal is to identify the most effective MAP management technique by measuring serum lactate peaks as indicators of tissue hypoxia. Secondary outcomes include intraoperative oxygenation parameters and major postoperative complications, contributing to enhanced cardiac surgery results.

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March 20, 2024
Microbubbles

The Number of Microbubbles Generated During Cardiopulmonary Bypass Can Be Estimated Using Machine Learning From Suction Flow Rate, Venous Reservoir Level, Perfusion Flow Rate, Hematocrit Level, and Blood Temperature

This study introduces a neural network-based model to estimate the count rate of microbubbles (MBs) in cardiopulmonary bypass (CPB) systems, using suction flow rate, venous reservoir level, perfusion flow rate, hematocrit level, and blood temperature. Through perfusion experiments and clinical applications, the model demonstrated high accuracy (R2 > 0.95) and a strong correlation in clinical settings (R2 = 0.8576). This innovation could significantly enhance patient safety and outcomes by enabling precise monitoring and potentially reducing the risk of MB-associated complications in cardiac surgery.

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March 17, 2024
Cardiac BP

Hemodynamic Monitoring In The Cardiac Surgical Patient: Comparison of Three Arterial Catheters

This study evaluates three arterial catheter placement strategies (Radial Short, Radial Long, and Brachial Long) for hemodynamic monitoring in cardiac surgery. Conducted at a single academic university hospital, it involved adult patients undergoing non-emergent cardiac surgery with cardiopulmonary bypass. The findings indicate that both Radial Long and Brachial Long catheter placements offer superior systemic systolic arterial pressure (SAP) and mean arterial pressure (MAP) monitoring compared to the Radial Short strategy. Specifically, the Brachial Long placement showed superior results in MAP gradients post-CPB, and lesser need for femoral line placement and vasopressin administration, underscoring the effectiveness of longer catheters in critical care.

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March 11, 2024
CPB TIME

The Effect of Surgery Started at Different Time Points During the Day on the Clinical Outcomes of Mitral Valve Surgery

This study investigates the impact of mitral valve surgery conducted at different times of the day (morning, afternoon, and evening) on short-term and long-term clinical outcomes. Across 947 patients from January 2018 to December 2020, divided into morning, afternoon, and evening groups based on surgery start time, results showed no significant differences in long-term mortality, stroke risk, reoperation rates, or in-hospital outcomes such as cardiopulmonary bypass time and ICU length of stay. The study concludes that mitral valve surgery is safe regardless of the time of day it is performed.

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March 8, 2024
CPB Time

Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting

This study examines the impact of the time difference between cardiopulmonary bypass and aortic cross-clamping on complications after coronary artery bypass grafting. Analyzing data from 3,090 patients, it identifies a correlation between increased time differences and higher risks of reoperation, stroke, kidney failure, and in-hospital mortality. The findings suggest that the time difference serves as a significant predictive factor for postoperative complications, highlighting the importance of incorporating this metric in future research for better complication prediction.

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March 7, 2024
AKI Pressure

Higher Perfusion Pressure and Pump Flow During Cardiopulmonary Bypass Are Beneficial for Kidney Function-A Single-Centre Prospective Study

This study investigates the impact of higher mean arterial pressure (MAP) and pump flow during cardiopulmonary bypass (CPB) on kidney function. One hundred nine patients were divided into groups with standard and increased CPB pump flow to maintain MAP > 90 mmHg. Results showed that a higher MAP did not affect the incidence of acute kidney injury but improved intraoperative and postoperative diuresis and reduced renin release. Additionally, higher MAP did not increase cerebrovascular complications and may reduce postoperative delirium incidence, suggesting that maintaining MAP > 90 mmHg during CPB is beneficial for kidney function and potentially for the central nervous system.

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March 3, 2024
Heart Brain

Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion

This study investigates the impact of pulsatile and non-pulsatile cardiopulmonary bypass (CPB) techniques on cerebral perfusion in coronary artery bypass grafting surgeries. Using near-infrared spectroscopy for cerebral oximetry monitoring, S100β protein levels, and neurocognitive function tests, it was found that pulsatile perfusion may offer benefits for cerebral perfusion based on specific biomarker levels, despite no significant differences in neurocognitive outcomes between groups. The findings suggest further research is needed to fully understand the advantages of pulsatile flow for cerebral health post-surgery.

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March 1, 2024
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