Although goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) has been discussed extensively in adult studies, no pediatric indexed oxygen delivery (Do₂i) thresholds are universally accepted, and no pediatric randomized controlled trial has been reported. This study aimed to determine whether the GDP initiative (maintaining Do₂i ≥360 mL/min/m² during CPB) could reduce the incidence of acute kidney injury (AKI) after pediatric cardiac operation and improve clinical outcomes.

This single-center randomized controlled trial enrolled 312 pediatric patients, who were randomized to receive either the GDP strategy or a conventional perfusion strategy during CPB. The primary outcome was the rate of postoperative AKI. Secondary outcomes included major postoperative complications, all-cause mortality within 30 days, and short-term clinical outcomes after operation.

AKI occurred in 43 patients (28.1%) in the GDP group and in 65 patients (42.2%) in the control group (relative risk, 0.67; 95% CI, 0.49-0.91; P = .010). In the subgroup analysis, the GDP group had a lower AKI rate compared with the control group among patients aged less than 1 year, with a nadir temperature greater than 32 °C and a nadir hemoglobin value less than 8 g/L during CPB, with preoperative cyanosis, and with CPB duration from 60 to 120 minutes.

The GDP strategy aimed at maintaining Do₂i ≥360 mL/min/m² during CPB is effective in reducing the risk of AKI after pediatric cardiac operation.