Delivery of oxygen during cardiopulmonary bypass and associated clinical outcomes among adult cardiac surgery patients: A systematic review
Why this work is in the frame
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Bibliographic record
Abstract
Purpose Oxygen delivery (DO 2 ) during cardiopulmonary bypass (CPB) is critical in preventing postoperative complications in adult cardiac surgery. This systematic review aimed to assess the relationship between intraoperative DO 2 during CPB, particularly within Goal-directed Perfusion (GDP) strategies, and associated clinical outcomes. Methods A systematic search of MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, PROSPERO, and Cochrane was conducted from database inception through December 2024, adhering to PRISMA 2020 guidelines. Studies reported intraoperative DO 2 measurements and their relationship with clinical outcomes among adults undergoing cardiac surgery with CPB. Data extraction and quality assessment were performed independently by two reviewers. Results Thirty-nine studies (71,050 patients) were included, with acute kidney injury (AKI) being the most frequently studied outcome (84.6% of studies). A consistent association was found between lower intraoperative DO 2 and increased risk of AKI, intraoperative lactate elevations, and prolonged mechanical ventilation. Five randomized controlled trials (RCTs) demonstrated that maintaining DO 2 levels, indexed to body surface area (iDO 2 ), above a threshold of 270–300 mL/min/m 2 significantly reduced the risk of postoperative AKI. However, evidence linking DO 2 management directly to reductions in mortality or neurologic complications remains limited, as well as studies reporting compliance with GDP strategies. Conclusion Maintaining adequate iDO 2 during CPB significantly reduces postoperative complications, especially AKI. These findings underscore the clinical relevance of GDP strategies, highlighting the importance of individualized perfusion management to optimize outcomes. Further large-scale RCTs are needed to confirm these benefits, standardize specific iDO 2 threshold levels that are beneficial, and to explore strategies that impact mortality and neurologic outcomes, as well as investigate the role that temperature management plays in DO 2 threshold determination.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.018 | 0.008 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it