A pilot study of the impact of enhanced cardiac index coupled with pulsatile flow on goal direct perfusion during cardiopulmonary bypass

A pilot study of the impact of enhanced cardiac index coupled with pulsatile flow on goal direct perfusion during cardiopulmonary bypass.   Introduction Providing sufficient organ perfusion during cardiopulmonary bypass (CPB) is a common research topic among extracorporeal technology researchers. CPB flow in the Cardiac Index (CI) calculation formula has a direct role in determining organ perfusion and oxygen delivery (DO2). The aim of this study is to evaluate organ perfusion with increased CI along with the use of pulsatile flow on cardiopulmonary bypass. Material and methods In this pilot study, thirty patients who were scheduled for on-pump coronary artery bypass graft (CABG) surgery with an estimated long CPB time were enrolled. Patients were randomly divided into two study groups. Patients in the control group were managed with a CI of 2.4 L/min/m2, while patients in the study group received a CI equal to 2.6 to 3 L/min/m2 with pulsatile flow (PF) throughout the bypass run. Lactate fluctuations, creatinine variation, inotrope needs, blood transfusion requirements, ICU and hospital length of stay were assessed and noted. Results Participants in the study group exhibited lower creatinine levels throughout the assessment period; however, this difference did not reach statistical significance (P>0.05). Participants in the study group consistently exhibited significantly lower lactate concentrations over the course of the investigation (P<0.05). Patients in the study groups experienced a reduced duration of both ICU and hospital lengths of stay; however, this difference did not reach statistical significance (P>0.05). Conclusion This prospective study concludes that an increased CI in conjunction with PF during CPB can markedly enhance organ perfusion, as evidenced by a statistically significant reduction in lactate production observed throughout the duration of the bypass. Key words: cardiac index, pulsatile flow, cardiopulmonary bypass, organ perfusion