Should We Add the Pulse Back? Testing heart–lung machine settings to make open-heart surgery safer.

Associate Professor Jonathon Fanning, The University of Queensland

Vanguard Grant

Years funded: 2026 - 2027

Should We Add the Pulse Back? Testing two heart–lung machine settings to make open-heart surgery safer.

Cardiopulmonary bypass (CPB) is essential during most cardiac surgeries, as it temporarily takes over the function of the heart and lungs. However, CPB is often associated with postoperative complications affecting vital organs, like the heart, kidneys and brain. One factor that may influence these outcomes is the type of blood flow that the CPB generates.

The standard practice is non-pulsatile continuous flow (CF), where blood is pumped steadily through the body. Alternatively, pulsatile flow (PF) mimics the natural pulsing nature of the heart, potentially offering better organ protection and reducing post-surgical complications by improving blood flow to vital organs. There is a lack of large-scale clinical trials comparing modern PF and CF cardiopulmonary bypass to provide definitive evidence to guide clinical practice.

This vanguard (initial) phase aims to evaluate feasibility, refine operational procedures, and optimise the protocol of the larger randomised controlled trial comparing PF and CF in high-risk cardiac surgery patients. We will recruit 250 patients scheduled for cardiac surgery across five major Australian cardiac surgical hospitals and randomly assign them to receive either PF or CF during CPB. Throughout the vanguard phase, we will evaluate recruitment strategies, protocol adherence, data collection methods and monitor for any safety concerns.

By refining these operational aspects, we will optimise the design of the larger national clinical trial. If the vanguard phase demonstrates that the study is feasible, the subsequent larger trial will seek to definitively determine whether PF can improve patient outcomes compared to CF. Ultimately, this research could lead to evidence-based changes in CPB clinical practice guidelines, enhancing recovery and reducing complications for patients undergoing cardiac surgery.

This study has been co-designed with cardiac surgeons, anaesthetists, perfusionists, researchers, and patients with lived experience of open-heart surgery. This will ensure the results are clinically meaningful and can be translated into practice quickly. If successful, we will share the findings widely through scientific publications, presentations at medical conferences, and summaries for patients and the public.