Critical oxygen delivery threshold during cardiopulmonary bypass in older cardiac surgery patients with increased frailty risk

Rosa M. Smoor, Eric P.A. Van Dongen, Lisa Verwijmeren, Inge A.A.M. Schreurs, Lisette M. Vernooij, Wilton A. Van Klei, Peter G. Noordzij*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


 : OBJECTIVES: Older patients have a higher cardiac surgery-associated acute kidney injury (CSA-AKI) related mortality. Low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is a risk factor for CSA-AKI, but critical DO2 thresholds for older patients are unknown. This study investigated critical DO2 thresholds for CSA-AKI in patients ≥70 years undergoing on-pump cardiac surgery. METHODS: Patients were enrolled from July 2015 until August 2017. CPB data from 432 patients were collected, and DO2 values were calculated per minute. The primary outcome was CSA-AKI. The association between DO2 and CSA-AKI was analysed with multivariable regression analysis. Multiple DO2 thresholds were analysed. The association between CSA-AKI and the area below the DO2 thresholds (DO2 deficit) was evaluated, as was the association between frailty and CSA-AKI. RESULTS: CSA-AKI occurred in 63 (14.6%) patients. Mean and nadir (lowest) DO2 values were lower in patients with CSA-AKI (283 vs 312 ml/min/m2; P-value <0.001 and 238 vs 270 ml/min/m2; P-value <0.001, respectively). The adjusted relative risk for CSA-AKI was 1.006 [99% confidence interval (CI) 1.001-1.012] per ml/min/m2 nadir DO2 decrease. The critical DO2 threshold was 270 ml/min/m2 [adjusted relative risk 2.06 (99% CI 1.33-2.80)]. The DO2 deficit below 270 ml/min/m2 was associated with CSA-AKI [adjusted relative risk 2.84 (99% CI 1.87-3.81)]. No association between frailty and CSA-AKI was found (P = 0.82). CONCLUSIONS: Low DO2 increased the risk for CSA-AKI in older patients who had cardiac surgery. A critical DO2 threshold of 270 ml/min/m2 was applicable for frail and non-frail patients. The efficacy of a DO2 >270 ml/min/m2 to reduce CSA-AKI in older patients needs further evaluation.

Original languageEnglish
Pages (from-to)685-692
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number3
Publication statusPublished - 1 Mar 2022


  • Acute kidney injury
  • Cardiopulmonary bypass
  • Elderly patients
  • Frailty
  • Oxygen delivery
  • Oxygen
  • Cardiopulmonary Bypass/adverse effects
  • Humans
  • Risk Factors
  • Postoperative Complications/etiology
  • Cardiac Surgical Procedures/adverse effects
  • Frailty/complications
  • Acute Kidney Injury/etiology
  • Aged


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