Cerebral Oxygenation-Guided Indexed-Flow Normothermic Cardiopulmonary Bypass with Vasopressor-Sparing Pressure Management: A Retrospective Descriptive Cohort Study.

Authors

Nikita Chibisov, Andrey Kornienko, Anatoly Malyshev, Evgeny Rodionov, Igor Glushenko, Mikhail Shtrymov

Published in

Annals of cardiac anaesthesia. Volume 29. Issue 4. Pages 587-593. Oct 01, 2026. Epub Oct 12, 2026.

Abstract

Mean arterial pressure targets during cardiopulmonary bypass remain debated; vasopressor-driven pressure augmentation may not improve oxygen delivery.
The aim of the paper is to describe clinical outcomes and physiologic markers during normothermic cardiopulmonary bypass managed with indexed flow, cerebral oximetry, calculated indexed oxygen delivery (DO2i), and vasopressor-sparing pressure management.
Single-center retrospective descriptive cohort study at a cardiac surgery center.
Consecutive adults undergoing elective or urgent cardiac surgery with normothermic cardiopulmonary bypass from June 2023 to December 2025 were included if complete anesthesia-perfusion, regional cerebral oxygen saturation (rSO2), circuit-derived venous oxygen saturation (SvO2), DO2i, and early outcome data were available. Circulatory arrest was excluded. Indexed pump flow was 2.2-2.4 L/min/m². Mean arterial pressure was interpreted with indexed flow, rSO2, SvO2, DO2i, hemoglobin, acid-base status, venous return, and surgical context. Baseline rSO2 was recorded before ventilation on room air; maximal relative decrease during bypass was recorded.
Descriptive statistics and Wilson 95% confidence intervals were used. No comparative testing or causal modeling was performed.
Two hundred patients were analyzed. Operating-room extubation was achieved in 172 patients (86.0%). Stroke occurred in six (3.0%), acute kidney injury in two (1.0%), and venoarterial extracorporeal membrane oxygenation was required in six (3.0%). Baseline right and left rSO2 were 57.5 ± 11.2% and 58.5 ± 11.3%; maximal relative rSO2 decrease was 28.5 ± 3.4%; circuit-derived SvO2 was 67.4 ± 5.9%; and calculated DO2i was 611 ± 74 mL/min/m².
This flow-oriented, cerebral oximetry-guided, oxygen-delivery-aware strategy was accompanied by favorable early recovery. Because the study was retrospective and noncomparative, the findings are hypothesis-generating.

PMID:
42862675
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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