Table E3.
Intra- and postoperative characteristics of 10,394 patients undergoing coronary artery bypass grafting, stratified by time period and use of agreed-upon cardiotomy suction practices
| Variables | Preintervention cardiotomy suction practice |
After intervention cardiotomy suction practice |
||||
|---|---|---|---|---|---|---|
| Nonadoption of agreed-upon practices | Adoption of agreed-upon practices | P value | Nonadoption of agreed-upon practices | Adoption of agreed-upon practices | P value | |
| Patients | 1297 | 2194 | 711 | 6192 | ||
| Intraoperative | ||||||
| Perfusion, min | 94.0 [72.0, 129.0] | 100.0 [77.0, 125.0] | .01 | 95.0 [73.0, 124.0] | 97.00 [73.0, 126.8] | .42 |
| Crossclamp, min | 71.0 [49.0, 99.0] | 80.0 [61.0, 102.0] | <.001 | 72.0 [51.0, 95.0] | 75.0 [54.0, 101.0] | .01 |
| Heparin management | ||||||
| Method of determining initial heparin dose | ||||||
| Fixed weight-based | 1078 (83.4) | 1781 (81.7) | .19 | 581 (81.8) | 5370 (87.0) | .0002 |
| Heparin dose response | 214 (16.6) | 399 (18.3) | 129 (18.2) | 805 (13.0) | ||
| Total dose for CPB, units | 31,000 [28,000, 40,000] | 34,000 [30,000, 40,000] | .0003 | 30,000 [27,000, 39,000] | 340,000 [30,000, 40,000] | <.0001 |
| Anticoagulation monitoring | ||||||
| Method for monitoring | ||||||
| Activated clotting time | 1268 (99.6) | 2180 (99.4) | .43 | 693 (99.9) | 6165 (99.7) | .99 |
| Heparin concentration | 51 (4.0) | 227 (10.4) | <.0001 | 10 (1.44) | 329 (5.3) | <.0001 |
| PT/PTT | 0 (0) | 1 (0.05) | .99 | 0 (0) | 0 (0) | NA |
| Other | 2 (0.2) | 2 (0.1) | .63 | 0 (0) | 0 (0) | NA |
| Retrograde autologous priming | 1231 (94.9) | 1799 (82.0) | <.0001 | 674 (94.8) | 5255 (84.9) | <.0001 |
| Static prime volume, mL | 910.0 [900.0, 1053.0] | 930 [820.0, 1100.0] | .01 | 910.0 [900.0, 1053.0] | 910.0 [820.0, 1000.0] | <.0001 |
| Use of antifibrinolytics | ||||||
| Coagulation monitoring | ||||||
| No | 930 (73.1) | 1317 (60.1) | <.0001 | 468 (67.4) | 4339 (70.2) | 0.13 |
| Yes, before CPB | 85 (6.7) | 651 (29.7) | <.0001 | 19 (2.7) | 1204 (19.5) | <.0001 |
| Yes, during CPB | 3 (0.2) | 194 (8.9) | <.0001 | 1 (0.1) | 299 (4.8) | <.0001 |
| Yes, after CPB cessation | 230 (18.1) | 519 (23.7) | .0001 | 78 (11.2) | 1128 (18.3) | <.0001 |
| Return to cardiopulmonary bypass (yes) | 22 (1.7) | 50 (2.3) | .24 | 12 (1.7) | 133 (2.2) | .42 |
| Hemodynamic instability | 16 (1.2) | 34 (1.6) | .45 | 6 (0.8) | 66 (1.1) | .58 |
| Technical | 8 (0.6) | 23 (1.1) | .19 | 6 (0.8) | 73 (1.2) | .43 |
| Other | 0 (0.0) | 1 (0.1) | 1.00 | 1 (0.1) | 5 (0.1) | .48 |
| Red cell transfusion | .96 | .25 | ||||
| 0 | 1149 (88.6) | 1939 (88.4) | 609 (85.7) | 5414 (87.4) | ||
| 1-2 | 122 (9.4) | 214 (9.8) | 84 (11.8) | 625 (10.1) | ||
| ≥3 | 26 (2.0) | 41 (1.8) | 18 (2.5) | 151 (2.5) | ||
| Hematocrit | ||||||
| Nadir on CPB | 25.8 [22.0, 29.0] | 26.0 [23.0, 30.0] | <.001 | 24.2 [21.0, 28.0] | 26.0 [22.9, 29.6] | <.001 |
| Before first RBC transfusion | 20.0 [17.5, 22.0] | 20.0 [18.0, 23.0] | .03 | 20.0 [18.0, 21.0] | 20.0 [18.0, 22.0] | .14 |
| Before second RBC transfusion | 20.5 [19.0, 23.0] | 20.0 [18.0, 23.0] | .74 | 20.5 [19.0, 26.0] | 20.0 [19.0, 22.0] | .18 |
| Intra-aortic balloon pump | 17 (1.3) | 40 (1.8) | .31 | 11 (1.5) | 100 (1.6) | 1.00 |
| Conventional ultrafiltration | 279 (21.5) | 394 (18.0) | .01 | 133 (18.7) | 1036 (16.7) | .20 |
| Ultrafiltration volume per kg, mL/kg | 17.8 [11.2, 30.0] | 13.9 [8.7, 23.8] | <.0001 | 18.02 [9.9, 30.7] | 12.69 [8.,0, 21.5] | <.001 |
| Nadir hematocrit on cardiopulmonary bypass | 25.8 [22.0, 29.0] | 26.0 [23.0, 30.0] | <.001 | 24.2 [21.0, 28.0] | 26.0 [22.9, 29.6] | <.001 |
| Cardiotomy suction | ||||||
| Not used | 0 (0.0) | 609 (27.8) | <.0001 | 0 (0.0) | 346 (5.6) | <.0001 |
| Used and stopped before protamine | 0 (0.0) | 1585 (72.2) | <.0001 | 0 (0.0) | 5846 (94.4) | <.0001 |
| Protamine dosing, mg | 300.0 [300.0, 400.0] | 300.0 [250.0, 450.0] | .97 | 300.0 [300.0, 350.0] | 300.0 [250.0, 400.0] | .002 |
| Method for calculating initial protamine dose | ||||||
| Fixed dose | 25 (1.9) | 302 (13.9) | <.0001 | 11 (1.6) | 298 (4.8) | <.0001 |
| Heparin protamine titration | 302 (23.4) | 203 (9.3) | 174 (24.5) | 782 (12.7) | ||
| Ratio dose of heparin given | 963 (74.5) | 1640 (75.2) | 525 (73.9) | 4997 (80.9) | ||
| Protamine not given | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Other | 2 (0.2) | 36 (1.7) | 0 (0) | 98 (1.6) | ||
| Non-RBC transfusion (amount in units) | ||||||
| In prime | ||||||
| Fresh-frozen plasma | 0 [0, 0] | 0 [0, 0] | .13 | 0 [0, 0] | 0 [0,0] | .68 |
| During CPB | ||||||
| Platelets | 0 [0, 0] | 0 [0, 0] | .48 | 0 [0, 0] | 0 [0, 0] | .50 |
| Fresh-frozen plasma | 0 [0, 0] | 0 [0, 0] | .83 | 0 [0, 0] | 0 [0, 0] | .11 |
| Non-CPB | ||||||
| Platelets | 2 [1, 2] | 2 [1, 2] | .83 | 1 [1, 2] | 1 [1, 2] | .61 |
| Fresh-frozen plasma | 2 [1, 2] | 2 [2, 2] | .82 | 2 [1, 2] | 2 [2, 2] | .07 |
| Autotransfusion device used | 1188 (91.6) | 2182 (99.5) | <.0001 | 645 (90.7) | 6150 (99.3) | <.0001 |
| Evidence of clot in circuit | 14 (1.1) | 9 (0.4) | .02 | 3 (0.4) | 24 (0.4) | .75 |
| Postoperative | ||||||
| Red cell transfusion, % | .07 | .16 | ||||
| 0 | 1038 (80.0) | 1693 (77.2) | 564 (79.3) | 4678 (75.5) | ||
| 1-2 | 193 (14.9) | 369 (16.8) | 103 (14.5) | 1087 (17.6) | ||
| ≥3 | 66 (5.1) | 132 (6.0) | 44 (6.2) | 427 (6.9) | ||
| Reoperation for bleeding, % | 16 (1.2) | 41 (1.9) | .20 | 13 (1.8) | 114 (1.8) | 1.00 |
| Renal failure, % | 20 (1.6) | 45 (2.1) | .31 | 20 (2.9) | 117 (1.9) | .09 |
| Stroke, % | 10 (0.8) | 27 (1.2) | .21 | 8 (1.1) | 87 (1.4) | .56 |
| Intensive care unit, h | 52.9 [39.8, 92.9] | 49.9 [26.6, 88.7] | <.001 | 53.0 [30.4, 95.9] | 47.5 [25.1, 78.5] | <.001 |
| Ventilation time, h | 5.5 [4.0, 8.8] | 5.2 [3.7, 8.9] | .00 | 5.4 [3.9, 8.2] | 5.1 [3.6, 7.9] | .01 |
| Operative mortality, % | 5 (0.4) | 9 (0.4) | 1.00 | 4 (0.6) | 39 (0.6) | 1.00 |
CPB, Cardiopulmonary bypass; PT/PTT, prothrombin time/partial thromboplastin time; NA, not available; RBC, red blood cell.