Using a quality improvement initiative to reduce acute kidney injury during on-pump coronary artery bypass grafting

Mitchell A. Katona, Joshua L. Walker, Nitin A. Das, Stewart R. Miller, Edward Y Sako

Research output: Contribution to journalArticle

Abstract

Introduction: In response to a perceived high incidence of acute kidney injury following cardiopulmonary bypass at our institution, a quality improvement initiative consisting of a systematic change to a delivered oxygen (DO2) goal-directed perfusion practice was implemented. We sought to maintain DO2 > 270 mL/min/m2 to reduce the incidence of acute kidney injury. Methods: ’The study population included all patients receiving isolated, non-emergent, on-pump coronary artery bypass grafting from January 2015 through December 2018, excluding patients requiring preoperative hemodialysis. DO2 goal-directed perfusion was instituted in February 2017. Acute kidney injury was defined using Acute Kidney Injury Network criteria. Results: The pre–goal-directed perfusion cohort included 257 patients, and the post–goal-directed perfusion cohort included 226 patients. The DO2 was significantly higher in the post–goal-directed perfusion group (p < 0.001). Postoperative change in serum creatinine and incidence of acute kidney injury were significantly lower in the post–goal-directed perfusion group (p < 0.001, p = 0.001, respectively). Estimation with probit and ordered probit models support these findings. Conclusion: This initiative confirms previous assertions that DO2 is a critical intraoperative parameter and should direct perfusion intervention accordingly.

Original languageEnglish (US)
JournalPerfusion (United Kingdom)
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • acute kidney injury
  • cardiac surgery
  • cardiopulmonary bypass
  • delivered oxygen
  • goal-directed perfusion
  • quality improvement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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