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Background: Post-cardiopulmonary bypass (CPB) blood processing is an important component of blood management during cardiac surgery. Purpose: The purpose of this study is to evaluate several methods of processing post-CPB residual blood. Research Design: Using a multi-institutional national database (SpecialtyCare Operative Procedural rEgistry [SCOPE]), 77,591 cardiac surgical operations performed in adults (>18 years) between January 2017 and September 2022 were reviewed. Study Sample: Blood processing methods included: Cell washing (CW, n = 63,592), Ultrafiltration (UF, n = 6286), Whole blood (WB, n = 3749), Hemobag (HB, n = 2480), and No processing (NO, n = 1484). The primary outcome was intraoperative post-CPB allogenic red blood cell (RBC) transfusion. Data Analysis: Group differences in RBC transfusion were assessed using a Bayesian mixed-effects logistic regression model controlling for multiple operative variables. Results: Across blood processing groups, patients had similar ages, body mass index and surgical procedures performed as well as preoperative hematocrit and nadir operative hematocrit. Median hematocrit change from last-in-operating room to first-in-ICU were highest in UF and HB groups (3.0 [IQR = 2.0-4.8] and 2.5 [IQR = 0.4-5.0]), respectively. The model-predicted probability of intraoperative post-CPB RBC transfusion was lowest in the HB group (0.79% [95% CrI = 0.37%-1.26%]), and highest in NO group (2.12% [95% CrI = 1.47%-2.82%]). Relative to CW, the odds of RBC transfusion for HB cases were reduced by half (OR = 0.5 [95% CrI = 0.28-0.89], statistical reliability = 99.1%), while odds for NO were 1.41 greater (OR = 1.41 [95% CrI = 1.03-1.93], statistical reliability = 98.2%). Conclusions: Post-CPB blood processing affects the likelihood for both receiving an intraoperative post-CPB RBC transfusion and for hematocrit change, with HB use resulting in the lowest predicted risk for transfusion, and NO the highest., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Targeted oxygen delivery during cardiopulmonary bypass (CPB) has received significant attention due to its influence on patient outcomes, especially in mitigating acute kidney injury. While it has gained popularity in select institutions, there remains a gap in establishing it globally across multiple centers. The purpose of this investigation was to describe the development of a quality improvement process of targeted oxygen delivery during CPB across hospitals throughout the United States. A systematic approach to utilize oxygen delivery index (DO 2 i) as a key performance indicator within hospitals serviced by a national provider of perfusion services. The process included a review of the current literature on DO 2 i, which yielded a target nadir value (272 mL/min/m 2 ) and an area under the curve (DO 2 i 272 AUC) cut off of 632. All data is displayed on a dashboard with results categorized across multiple levels from system-wide to individual clinician performance. From January 2020 through December 2022, DO 2 i data from 91 hospitals and 11,165 coronary artery bypass graft procedures were collected. During this period the monthly proportion of DO 2 i measurements above the target nadir DO 2 i 272 ranged from 60.5% to 78.4% with a mean+/-SD of 70.8 +/- 4.2%. Binary logistic regression for the first 7 months following monthly DO 2 i performance reporting has shown a statistically significant positive linear trend in the probability of achieving the target DO 2 i 272 ( p < .001), with a crude increase of approximately 7.8% for DO 2 i 272 AUC, and a 73.8% success rate ( p < .001). A survey was sent to all individuals measuring oxygen delivery during CPB to assess why a target DO 2 i 272 could not be reached. The two most common responses were an 'inability to improve CPB flow rates' and 'restrictive allogeneic red blood cell transfusion policies'. This study demonstrates that targeting a minimum level of oxygen delivery can serve as a key performance indicator during CPB using a structured quality improvement process., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ultrafiltration (UF) is a common practice during cardiopulmonary bypass (CPB) where it is used as a blood management strategy to reduce red blood cell (RBC) transfusion, minimize adverse effects of hemodilution, and reduce proinflammatory mediators. However, its clinical utilization has been shown to vary throughout the continents., Purpose: The purpose of this investigation was to assess the distribution of UF use across the United States., Data Collection: Data on UF use during cardiac surgery was obtained from a national (United States) perfusion database for adult cardiac procedures performed from January 2016 through December 2018., Study Sample: Four geographical regions were established: Northeast (NE), South (SO), Midwest (MW) and West (WE). The primary endpoint was the use of UF with secondary endpoints UF volume, CPB and anesthesia asanguineous volumes, intraoperative allogeneic RBC transfusion, nadir hematocrit and urine output (UO). 92,859 adult cardiac cases from 191 hospitals were reviewed., Results: The NE and the WE had similar usages of UF (59.9% and 59.7% respectively), which were higher than the MW and the SO (38.6% and 34.9%, p < .001). When UF was utilized, the median [IQR] volume removed was highest in the NE (1900 [1200-2800]mL), and similar in all other regions (WE 1500 [850-2400 mL, MW 1500 [900-2300]mL and SO 1500 [950-2200]mL, p < .001. Median total UO was lowest in the NE 400 [210,650]mL vs all other regions ( p < .001), and remained so when indexed by patient weight and operative time (NE-0.8 [0.5, 1.3]mL/kg/hour, MW-1.1 [0.7, 1.8] mL/kg/hour, SO-1.3 [0.8, 2.0]mL/kg/hour, WE-1.1 [0.7, 1.3]mL/kg/hour, p < .001. Intraoperative RBC transfusion rate was highest in the SO (21.3%) and WE (20.5%), while similar rates seen in the NE (16.2%) and MW (17.6%), p < .001., Conclusions: Across the United States there is geographic variation on the use of UF. Further research is warranted to investigate why these practice variations exist and to better understand and determine their reasons for use., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.