Examining hemodynamic parameters required for goal-directed perfusion optimizing oxygen supply-demand balance during pediatric cardiopulmonary bypass

Abstract

Goal-directed perfusion（GDP）management is widely used in adult cardiac surgery to avoid oxygen supply-demand imbalance and tissue hypoxia. This study retrospectively reviewed parameters during cardiopulmonary bypass（CPB）that may be useful for pediatric GDP.

Patients under 15 years of age（excluding neonates）who underwent open heart surgery for acyanotic congenital heart disease at Kobe Children’s Hospital between 2016 and 2020 were evaluated, and divided into 2 groups according to whether lactate during CPB was < 2 mmol/L（Group L）or ≥ 2 mmol/L（Group H）. Using selected covariables of patient characteristics and operative data, propensity score matching was conducted for comparison of these groups.

There were 227 consecutive patients（Group L, 193; Group H, 34）. Before propensity score matching, O₂ER was significantly higher and VCO_2i, P（v-a）CO₂, and P（v-a）CO₂/C（a-v）O₂ were significantly lower in Group L compared with Group H. Propensity score matching identified each 34 patients for each group. After matching, DO_2i was significantly higher and P（v-a）CO₂ and P（v-a）CO₂/C（a-v）O₂ were significantly lower in Group L compared with Group H. Lactate on arrival at intensive care unit was significantly lower in Group L before and after matching. The cutoff value of DO_2i for lactate ≥ 2 mmol/L during CPB, which can be observed intraoperatively in real time, was 389 mL/min/m² according to the ROC curve.

DO_2i is useful for pediatric GDP in the same way of adult GDP. Moreover, P（v-a）CO₂ and P（v-a）CO₂/C（a-v）O₂ could be used as additional important parameters for pediatric GDP.