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

CONTEXT: Mean arterial pressure targets during cardiopulmonary bypass remain debated; vasopressor-driven pressure augmentation may not improve oxygen delivery.

AIMS: 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.

SETTINGS AND

DESIGN

Single-center retrospective descriptive cohort study at a cardiac surgery center.

MATERIAL AND

METHODS

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.

STATISTICAL ANALYSIS USED: Descriptive statistics and Wilson 95% confidence intervals were used. No comparative testing or causal modeling was performed.

RESULTS

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.

CONCLUSIONS

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.