Technique Articles

A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery

^* Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts
^† Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; and
^‡ Harvard Medical School, Cambridge, Massachusetts

Address correspondence to: Geoffrey Rance, BS, CCP, VA Boston Healthcare System, Division of Cardiac Surgery, 1400 VFW Parkway, Mail Stop 112, West Roxbury, MA 02132. E-mail: geoffrey.rance@va.gov

Received: 31 May 2019
Accepted: 2 August 2019

Abstract

Traditionally, blood flow rates on cardiopulmonary bypass are based primarily on a formula that matches cardiac index to the patient’s body surface area (BSA). However, Ranucci and associates in the Goal-Directed Perfusion Trial (GIFT) trial have shown that coupling the BSA with delivery of oxygen (DO₂), known as goal-directed perfusion (GDP), may be a safer approach to determine appropriate blood flows. The objective of this study was to create a GDP reference tool that would allow perfusionists to quickly determine the lowest acceptable blood flow needed to provide a patient of any BSA with a satisfactory DO₂ without the need for additional dedicated technology. We approached this problem by deriving a formula for flow (L/min), based on BSA, oxygen content of the blood, and a minimum DO₂ of 280 mL·min⁻¹m⁻². A quick reference GDP chart was created based on the derived formula, requiring only the patient’s BSA and hemoglobin level to determine a safe minimum flow rate. The proposed tool allows any cardiac surgery center to adopt the GDP technique, even in the absence of instantaneous DO₂ monitoring equipment.