Original Articles

Global Cardioplegia Practices: Results from the Global Cardiopulmonary Bypass Survey

^* Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK;
^† Department of Anesthesia, Austin Health, Melbourne, Australia;
^‡ Department of Anesthesiology, National Institute of Cardiology, Rio-de-Janiero, Brazil; and
^§ Department of Anesthesia, Royal Papworth Hospital, Cambridge, UK

Address correspondence to: Jason M. Ali, PhD, Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge CB23 3RE, UK. E-mail: ja297@cam.ac.uk

Received: 23 September 2017
Accepted: 15 February 2018

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.