A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery

J. Trent Magruder, Todd C. Crawford, Herbert Lynn Harness, Joshua C. Grimm, Alejandro Suarez-Pierre, Chad Wierschke, Jim Biewer, Charles Hogue, Glenn R. Whitman, Ashish S. Shah, Viachaslau Barodka

Research output: Contribution to journalArticle

Abstract

Background We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. Methods On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m2 and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery. Results We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m2, P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001). Conclusions The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study.

Original languageEnglish (US)
Pages (from-to)118-125.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume153
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Acute Kidney Injury
Thoracic Surgery
Incidence
Cardiopulmonary Bypass
Creatinine
Oxygen
Phenylephrine
Quality Improvement
Glomerular Filtration Rate
Serum

Keywords

  • acute kidney injury
  • cardiopulmonary bypass
  • CPB inflammatory response
  • goal-directed perfusion
  • kidney
  • postoperative care
  • renal failure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Magruder, J. T., Crawford, T. C., Harness, H. L., Grimm, J. C., Suarez-Pierre, A., Wierschke, C., ... Barodka, V. (2017). A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery, 153(1), 118-125.e1. DOI: 10.1016/j.jtcvs.2016.09.016

A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery. / Magruder, J. Trent; Crawford, Todd C.; Harness, Herbert Lynn; Grimm, Joshua C.; Suarez-Pierre, Alejandro; Wierschke, Chad; Biewer, Jim; Hogue, Charles; Whitman, Glenn R.; Shah, Ashish S.; Barodka, Viachaslau.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 153, No. 1, 01.01.2017, p. 118-125.e1.

Research output: Contribution to journalArticle

Magruder JT, Crawford TC, Harness HL, Grimm JC, Suarez-Pierre A, Wierschke C et al. A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery. 2017 Jan 1;153(1):118-125.e1. Available from, DOI: 10.1016/j.jtcvs.2016.09.016

Magruder, J. Trent; Crawford, Todd C.; Harness, Herbert Lynn; Grimm, Joshua C.; Suarez-Pierre, Alejandro; Wierschke, Chad; Biewer, Jim; Hogue, Charles; Whitman, Glenn R.; Shah, Ashish S.; Barodka, Viachaslau / A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 153, No. 1, 01.01.2017, p. 118-125.e1.

Research output: Contribution to journalArticle

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N2 - Background We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. Methods On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m2 and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery. Results We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m2, P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001). Conclusions The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study.

AB - Background We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. Methods On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m2 and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery. Results We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m2, P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001). Conclusions The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study.

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