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Cited by 100Hemodynamic Monitoring and TherapyCardiac and Coronary Surgery TechniquesCongenital Heart Disease Studies

Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery

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Ranucci, Marco, Isgrò, Giuseppe, Carlucci, Concetta, De La Torre, Teresa, Enginoli, Stefania, Frigiola, Alessandro, Surgical and Clinical Outcome REsearch (SCORE) Group·2010·Critical Care
DOI 10.1186/cc9217PMC PMC2945132
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Abstract

INTRODUCTION: Central venous oxygen saturation and blood lactate are different indices of the adequacy of oxygen delivery to the oxygen needs. In pediatric cardiac surgery, lactate level and kinetics during and after cardiopulmonary bypass are associated with outcome variables. The aim of this study was to explore the hypothesis that the lowest central venous oxygen saturation and the peak lactate value during cardiopulmonary bypass, used alone or in combination, may be predictive of major morbidity and mortality in pediatric cardiac surgery. METHODS: We conducted a retrospective analysis of 256 pediatric (younger than 6 years) patients who had undergone cardiac surgery with continuous monitoring of central venous oxygen saturation and serial measurement of blood lactate. RESULTS: Peak lactate was significantly increased when the nadir central venous oxygen saturation was < 68%. Both nadir central venous oxygen saturation and peak lactate during cardiopulmonary bypass were independently associated with major morbidity and mortality, with the same accuracy for major morbidity and a higher accuracy of peak lactate for mortality. A combined index (central venous oxygen saturation < 68% and peak lactate > 3 mmol/L) provided the highest sensitivity and specificity for major morbidity, with a positive predictive value of 89%. CONCLUSIONS: The combination of a continuous monitoring of central venous oxygen saturation and serial measurements of blood lactate during cardiopulmonary bypass may offer a predictive index for major morbidity after cardiac operations in pediatric patients. This study generates the hypothesis that strategies aimed to preserve oxygen delivery during cardiopulmonary bypass may reduce the occurrence of low values of central venous oxygen saturation and elevated lactate levels. Further studies should consider this hypothesis and take into account other time-related factors, such as time of exposure to low values of central venous oxygen saturation and kinetics of lactate formation.

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  • In pediatric patients undergoing cardiac surgery, ScvO2 levels < 68% associated with lactate concentrations > 3 mmol/L during cardiopulmonary bypass have been correlated with increased morbidity and mortality.

    “In pediatric patients undergoing cardiac surgery, ScvO2 levels < 68% associated with lactate concentrations > 3 mmol/L during cardiopulmonary bypass have been correlated with increased morbidity and mortality [38].”

    From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [38]

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Authors
Ranucci, M., Isgrò, G., Carlucci, C., De La Torre, T., Enginoli, S., Frigiola, A., & Surgical and Clinical Outcome REsearch (SCORE) Group
Affiliations
IRCCS Policlinico San Donato (IT)
Corresponding author
Ranucci, Marco
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2010-08-04
Volume
14
Issue
4
Pages
R149-R149
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/cc9217
PMC
PMC2945132
OpenAlex
W1563139376
Cited by
100
References
29
Citations by year
2026: 7 · 2025: 7 · 2024: 4 · 2023: 8 · 2022: 7 · 2021: 5 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 9 · 2015: 8 · 2014: 7 · 2013: 4 · 2012: 7
FWCI
5.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
Keywords
central venous oxygen saturation, blood lactate, cardiopulmonary bypass, pediatric cardiac surgery, postoperative morbidity, postoperative mortality, oxygen delivery, lactate kinetics, prognostic factors
MeSH terms
Cardiopulmonary Bypass, Female, Cardiac Surgical Procedures, Humans, Infant, Lactates, Length of Stay, Male, Oxygen, Regression Analysis, Retrospective Studies, ROC Curve, Logistic Models, Odds Ratio, Treatment Outcome, Statistics, Nonparametric

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