A decline in kidney function is common after cardiac surgery. It is associated with more complication and increased length of stay. Mitigating this decline of kidney function will therefore improve patient outcomes and reduce costs. During cardiac surgery, cardiopulmonary bypass (CPB) is commonly utilised to deliver blood around the body and supply oxygen to vital organs. However, the use of CPB is known to decrease the blood flow to the kidneys compared to the normal state. This puts the kidneys at risk of not receiving adequate oxygen (termed hypoxia) and therefore contributes to loss of kidney function. Increasing CPB flows has minimised kidney hypoxia in small studies. This intervention has no cost and no known harms, and has excellent potential to improve patient outcomes, However, the benefit of routinely increased CPB flows has not been tested in real-world settings. Therefore, increased CPB flows are not routinely practiced in Australia or the world.
In order to work towards a large pragmatic trial that applies high CPB flows routinely for patients undergoing cardiac surgery, we aim to demonstrate the feasibility of a pragmatic application of different CPB flow targets during cardiopulmonary bypass in two representative cardiac surgery centres: one from a metropolitan setting, and one from a regional setting. This will allow us to have greater confidence in administering different CPB flow targets in a large trial setting.
Dr Raymond Hu, Professor Rinaldo Bellomo, Austin Health and The University of Melbourne, Victoria; Professor Robert Baker, Flinders Medical Centre, South Australia; Professor Jaishankar Raman, Townsville University Hospital, Queensland.
The project was awarded A$36,310 funding through the ANZCA research grants program for 2025.