Original Article

A pilot study of the impact of enhanced cardiac index coupled with pulsatile flow on goal direct perfusion during cardiopulmonary bypass

¹ Extracorporeal Life Support, Baqiyatallah University of Medical Sciences, Tehran, Iran
² Tehran University of Medical Sciences, Tehran, Iran
³ Baqiyatallah University of Medical Sciences, Tehran, Iran
⁴ Midwestern University, College of Health Sciences, Cardiovascular Science Program, 19555 N. 59TH Avenue Glendale, AZ 85308 USA

^* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 7 April 2025
Accepted: 12 October 2025

Abstract

Introduction: Providing sufficient organ perfusion during cardiopulmonary bypass (CPB) is a common research topic among extracorporeal technology researchers. The application of an elevated cardiac index (CI) to enhance CPB flow, coupled with the adoption of pulsatile flow, constitutes a novel approach designed to improve organ perfusion and oxygen delivery (DO2). this study aims to assess the effects of increased CI and pulsatile flow on organ perfusion during CPB. Material and methods: In this pilot study, thirty patients scheduled for on-pump coronary artery bypass graft (CABG) surgery with an estimated prolonged CPB time were enrolled. Patients were randomly divided into two study groups. Patients in the control group were managed with a CI of 2.4 L/min/m², while patients in the study group received a CI equal to 2.6 to 3 L/min/m² with pulsatile flow (PF) throughout the bypass run. Lactate fluctuations, creatinine variation, inotrope needs, blood transfusion requirements, ICU and hospital length of stay were assessed and noted. Results: Participants in the study group exhibited lower creatinine levels throughout the assessment period; however, this difference did not reach statistical significance (P > 0.05). Participants in the study group consistently exhibited significantly lower lactate concentrations over the course of the investigation (P < 0.05). Patients in the study groups experienced a reduced duration of both ICU and hospital lengths of stay; however, this difference did not reach statistical significance (P > 0.05). Conclusion: This prospective study concludes that an increased CI in conjunction with PF during CPB can markedly enhance organ perfusion, as evidenced by a statistically significant reduction in lactate production observed throughout the duration of the bypass.