Goal Directed Perfusion

Created: October 01, 2023

Last Updated: November 18, 2023

Contributor(s):

Christa Kampert MHA CCP LP

ERAS Cardiac Collaborative Network

Editor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Alexander Gregory MD FRCPC

Summary

Goal-directed perfusion in cardiac surgery is an individualized approach to managing cardiopulmonary bypass to optimize tissue and organ perfusion, reduce complications, and improve postoperative outcomes. It involves continuous monitoring and adjustment of perfusion parameters based on real-time physiological data to ensure each patient’s specific needs are met during surgery.

Goal-directed perfusion (GDP) in cardiac surgery refers to a tailored approach to managing cardiopulmonary bypass (CPB) based on individual patient’s physiological responses. This strategy aims to optimize organ and tissue perfusion, minimize systemic inflammation, and reduce the complications associated with CPB.

Key Objectives of Goal-Directed Perfusion

Optimizing Oxygen Delivery:

  • Ensuring adequate oxygenation and tissue perfusion by monitoring and adjusting parameters like flow rates, pressure, and hematocrit levels to meet individual patient’s needs.

Minimizing Hemodilution:

  • Managing fluid balance to reduce excessive hemodilution, which can impair oxygen delivery to tissues.

Temperature Management:

  • Controlling patient temperature to optimize metabolic demands and reduce the risk of hypothermia or hyperthermia during CPB.

Reducing Inflammation:

  • Utilizing techniques and equipment to mitigate the systemic inflammatory response triggered by CPB, such as biocompatible circuit coatings and leukocyte filters.

Monitoring End-Organ Perfusion:

  • Continuously assessing the perfusion to vital organs like the brain, kidneys, and heart, using various monitoring tools to ensure adequate blood flow and oxygenation.

Benefits of Goal-Directed Perfusion

Improved Clinical Outcomes:

  • GDP has been associated with reduced postoperative complications, including kidney injury, neurological deficits, and other organ dysfunctions.

Enhanced Recovery:

  • Patients undergoing GDP may experience quicker recoveries due to minimized organ injury and reduced inflammatory responses.

Resource Utilization:

  • By reducing complications and improving recovery, GDP can potentially lead to shorter hospital stays and reduced healthcare costs.

Personalized Care:

  • Tailoring perfusion strategies to individual patient’s needs ensures that each patient receives optimal care based on their specific physiological responses.

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This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

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Educational Materials

Goal-Directed Perfusion (GDP): An Overview
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss Goal-Directed Perfusion (GDP), including the components of a GDP bundle and the potential benefits.
GDP: Hemoconcentration
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss Goal-Directed Perfusion (GDP), with a particular focus on the evidence supporting options for hemoconcentration on CPB.
The Perfusionists Perspective During Cardiac Surgery
Christa Kampert, Chief Perfusionist from University of Maryland reviews the main aspects of optimal perfusion while on CPB from the perspective of the perfusionist.

References:

  1. Ranucci M, Romitti F, Isgrò G, Cotza M, Brozzi S, Boncilli A, Ditta A. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. Ann Thorac Surg. 2005 Dec;80(6):2213-20.
  2. Magruder JT, Weiss SJ, DeAngelis KG, Haddle J, Desai ND, Szeto WY, Acker MA; Penn Perfusion Team Working Group. Correlating oxygen delivery on cardiopulmonary bypass with Society of Thoracic Surgeons outcomes following cardiac surgery. J Thorac Cardiovasc Surg 2020; 19:S0022-5223(20)33322-5
  3. Ranucci M, Johnson I, Willcox T, Baker RA, Boer C, Baumann A et al. Goal-directed perfusion to reduce acute kidney injury: A randomized trial. J Thorac Cardiovasc Surg 2018;156: 1918-27.
  4. Magruder JT, Crawford TC, Harness HL, Grimm JC, Suarez-Pierre A, Wierschke C, Biewer J, Hogue C, Whitman GR, Shah AS, Barodka V. A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg. 2017 Jan;153(1):118-125.e1.
  5. Gao P, Liu J, Zhang P, Bai L, Jin Y, Li Y. Goal-directed perfusion for reducing acute kidney injury in cardiac surgery: A systematic review and meta- analysis. Perfusion 2022 Feb 6:2676591211073783.
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