Global Cardioplegia Practices: Results from the Global Cardiopulmonary Bypass Survey

Abstract

Despite the ubiquitous use of cardioplegia in cardiac surgery, there is a lack of agreement on various aspects of cardioplegia practice. To discover current cardioplegia practices throughout the world, we undertook a global survey to document contemporary cardiopulmonary bypass practices. A 16-question, Internet-based survey was distributed by regional specialist societies, targeting adult cardiac anesthesiologists. Ten questions concerned caseload and cardioplegia practices, the remaining questions examined anticoagulation and pump-priming practices. The survey was available in English, Spanish, and Portuguese. The survey was launched in June 2015 and remained open until May 2016. A total of 923 responses were analyzed, summarizing practice in Europe (269), North America (334), South America (215), and Australia/New Zealand (105). Inter-regional responses differed for all questions asked (p < .001). In all regions other than South America, blood cardioplegia was the common arrest technique used. The most commonly used cardioplegia solutions were: St. Thomas, Bretschneider, and University of Wisconsin with significant regional variation. The use of additives (most commonly glucose, glutamate, tris-hydroxymethyl aminomethane, and aspartate) varied significantly. This survey has revealed significant variation in international practice with regards to myocardial protection, and is a reminder that there is no clear consensus on the use of cardioplegia. It is unclear why regional practice groups made the choices they have and the clinical impact remains unclear.

Keywords: blood; cardioplegia; cardiopulmonary bypass; crystalloid.

Figure 1.

CONSORT-style diagram describing the distribution of received responses and the reasons for not considering certain responses in the final analysis.

Figure 2.

Distribution of arrest technique as used by individual respondents by region. ANZ, Australia/New Zealand.

Figure 3.

Distribution of type of chemical cardioplegia as used by individual respondents by region. ANZ, Australia/New Zealand.

Figure 4.

Distribution of dilution of blood cardioplegia as used by individual respondents by region. ANZ, Australia/New Zealand.