Hierarchy of regional oxygen delivery during cardiopulmonary bypass.
BACKGROUND
Relative to the nonbypass state, cardiopulmonary bypass may decrease whole-body oxygen (O2) delivery. We predicted that during cardiopulmonary bypass, a hierarchy of regional blood flow and O2 delivery could be characterized.


METHODS
In 8 46.5 +/- 1.2-kg pigs, fluorescent microspheres were used to determine blood flow and O2 delivery to five organ beds before and during 37 degrees C cardiopulmonary bypass at four randomized bypass flows (1.4, 1.7, 2.0, and 2.3 L/min/m2). At completion, 18 tissue samples were obtained from the cerebral cortex (n = 4), renal cortex (n = 2), renal medulla (n = 2), pancreas (n = 3), small bowel (n = 3), and limb muscle (n = 4) for regional blood flow determination.


RESULTS
At conventional cardiopulmonary bypass flow (2.3 L/min/m2), whole-body O2 delivery was reduced by 44 +/- 6% relative to the pre-cardiopulmonary bypass state (p < 0.05). Over a range of cardiopulmonary bypass flows (2.3 to 1.7 L/min/m2), brain and kidney maintained their perfusion. Blood flow and O2 delivery to both regions were reduced when the cardiopulmonary bypass flow was reduced to 1.4 L/min/m2. However, perfusion and O2 delivery to other visceral organs (pancreas, small bowel) and skeletal muscle showed pump flow dependency over the range of flows tested.


CONCLUSIONS
This study characterizes the organ-specific hierarchy of blood flow and O2 distribution during cardiopulmonary bypass. These dynamics are relevant to clinical decisions for perfusion management.
Boston
U S
US
Department of Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Slater
J M
JM
Orszulak
T A
TA
Cook
D J
DJ
D000818:Animals; D001921:Brain / Q000098:blood supply; D002315:Cardiopulmonary Bypass; D007421:Intestine, Small / Q000098:blood supply; D007668:Kidney / Q000098:blood supply; D018482:Muscle, Skeletal / Q000098:blood supply; D010100:Oxygen / Q000378:metabolism*; D010179:Pancreas / Q000098:blood supply; D012039:Regional Blood Flow; D013552:Swine
D010100:Oxygen