Abstract
Purpose
Oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is critical in preventing postoperative complications in adult cardiac surgery. This systematic review aimed to assess the relationship between intraoperative DO2 during CPB, particularly within Goal-directed Perfusion (GDP) strategies, and associated clinical outcomes.
Methods
A systematic search of MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, PROSPERO, and Cochrane was conducted from database inception through December 2024, adhering to PRISMA 2020 guidelines. Studies reported intraoperative DO2 measurements and their relationship with clinical outcomes among adults undergoing cardiac surgery with CPB. Data extraction and quality assessment were performed independently by two reviewers.
Results
Thirty-nine studies (71,050 patients) were included, with acute kidney injury (AKI) being the most frequently studied outcome (84.6% of studies). A consistent association was found between lower intraoperative DO2 and increased risk of AKI, intraoperative lactate elevations, and prolonged mechanical ventilation. Five randomized controlled trials (RCTs) demonstrated that maintaining DO2 levels, indexed to body surface area (iDO2), above a threshold of 270–300 mL/min/m2 significantly reduced the risk of postoperative AKI. However, evidence linking DO2 management directly to reductions in mortality or neurologic complications remains limited, as well as studies reporting compliance with GDP strategies.
Conclusion
Maintaining adequate iDO2 during CPB significantly reduces postoperative complications, especially AKI. These findings underscore the clinical relevance of GDP strategies, highlighting the importance of individualized perfusion management to optimize outcomes. Further large-scale RCTs are needed to confirm these benefits, standardize specific iDO2 threshold levels that are beneficial, and to explore strategies that impact mortality and neurologic outcomes, as well as investigate the role that temperature management plays in DO2 threshold determination.
Keywords
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
