Table E4.
Characteristics of 1420 patients undergoing coronary artery bypass grafting over the study period at non-Michigan centers, stratified by use of agreed-upon cardiotomy suction practices
| Variables | Cardiotomy suction practice |
||
|---|---|---|---|
| Nonadoption of agreed-upon practices | Adoption of agreed-upon practices | P value | |
| Patients | 800 | 620 | |
| Preoperative | |||
| Age, y | 65.0 [58.0, 72.0] | 65.0 [58.0, 72.0] | .78 |
| Body surface area, m2 | 2.0 [1.9, 2.2] | 2.0 [1.8, 2.2] | .71 |
| Female | 195 (24.4) | 105 (16.9) | .00 |
| Race | <.001 | ||
| Black | 125 (15.6) | 40 (6.5) | |
| Asian | 47 (5.9) | 79 (12.7) | |
| White and other | 628 (78.5) | 501 (80.8) | |
| Ejection fraction | 55.0 [45.0, 60.0] | 57.0 [49.0, 62.0] | .00 |
| Creatinine, mg/dL | 1.0 [0.80, 1.2] | 1.0 [0.90, 1.2] | .01 |
| Hematocrit | 40.1 [36.6, 44.0] | 40.9 [37.2, 43.6] | .41 |
| White blood cell count, thousands | 8.1 (2.6) | 8.1 (3.2) | .90 |
| Shock | 20 (2.5) | 14 (2.3) | .90 |
| Atrial fibrillation | 46 (5.8) | 15 (2.4) | .00 |
| Cardiac presentation at admission | <.001 | ||
| No symptom | 115 (14.4) | 32 (5.2) | |
| Stable angina | 153 (19.1) | 203 (32.7) | |
| Unstable angina | 222 (27.8) | 97 (15.6) | |
| Non-STEMI | 206 (25.8) | 200 (32.3) | |
| Other (includes STEMI) | 104 (13.0) | 88 (14.2) | |
| Cerebrovascular disease | 148 (18.5) | 100 (16.1) | .27 |
| Stroke | 63 (7.9) | 46 (7.4) | .83 |
| Diabetes and control method, % | .26 | ||
| Insulin diabetes | 174 (21.8) | 113 (18.2) | |
| Noninsulin diabetes | 236 (29.5) | 192 (31.0) | |
| Other or no diabetes | 390 (48.8) | 315 (50.8) | |
| New York Heart Association class III/IV, % | 68 (8.5) | 36 (5.8) | .07 |
| Home oxygen, % | 5 (0.6) | 3 (0.5) | 1.00 |
| Recent pneumonia, % | 23 (2.9) | 30 (4.8) | .07 |
| Recent smoker, % | 153 (19.1) | 78 (12.6) | .00 |
| Hypertension, % | 684 (85.5) | 545 (87.9) | .22 |
| Immunosuppressive therapy, % | 24 (3.0) | 24 (3.9) | .45 |
| Left main disease, % | 153 (19.1) | 129 (20.8) | .47 |
| Liver disease, % | 11 (1.4) | 18 (2.9) | .07 |
| Myocardial infarction within 7 d, % | 225 (28.1) | 198 (31.9) | .13 |
| Number of diseased vessels, % | .41 | ||
| One or fewer | 25 (3.1) | 27 (4.4) | |
| Two | 159 (19.9) | 129 (20.8) | |
| Three | 616 (77.0) | 464 (74.8) | |
| Previous cardiac intervention, % | 230 (28.7) | 182 (29.4) | .85 |
| Percutaneous coronary intervention within 6 h, % | 8 (1.0) | 2 (0.3) | .23 |
| Preoperative intra-aortic balloon pump or inotropes, % | 62 (7.8) | 24 (3.9) | .00 |
| Peripheral arterial disease, % | 84 (10.5) | 55 (8.9) | .35 |
| Dialysis, % | 25 (3.1) | 20 (3.2) | 1.00 |
| Status, % | <.001 | ||
| Elective | 389 (48.6) | 232 (37.4) | |
| Urgent | 382 (47.8) | 380 (61.3) | |
| Emergent | 29 (3.6) | 8 (1.3) | |
| Anticoagulants within 48 h, % | 332 (41.5) | 337 (54.4) | <.001 |
| Intraoperative | |||
| Perfusion, min | 94.0 [73.0, 116.0] | 90.0 [76.0, 111.0] | .29 |
| Crossclamp, min | 72.0 [53.0, 89.0] | 68.0 [54.0, 85.0] | .14 |
| Heparin management | |||
| Method of determining initial heparin dose | <.0001 | ||
| Fixed weight-based | 330 (41.6) | 23 (3.7) | |
| Heparin dose response | 464 (58.4) | 596 (96.3) | |
| Total dose for CPB, units | 30,000 [25,000, 35,000] | 25,000 [20,500, 30,000] | <.0001 |
| Anticoagulation monitoring | |||
| Method for monitoring | |||
| Activated clotting time | 622 (77.8) | 619 (99.8) | <.0001 |
| Heparin concentration | 464 (58.0) | 598 (96.5) | <.0001 |
| PT/PTT | 0 (0) | 0 (0) | NA |
| Other | 85 (10.6) | 596 (96.1) | <.0001 |
| Retrograde autologous priming | 719 (89.9) | 613 (98.9) | <.0001 |
| Static prime volume, mL | 950.0 [850.0, 1050.0] | 1100.0 [1100.0, 1650.0] | <.0001 |
| Use of antifibrinolytics | |||
| Coagulation monitoring | |||
| No | 557 (69.6) | 18 (2.9) | <.0001 |
| Yes, before CPB | 105 (13.1) | 599 (96.6) | <.0001 |
| Yes, during CPB | 5 (0.6) | 0 (0) | .07 |
| Yes, after CPB cessation | 2 (0.3) | 0 (0) | .51 |
| Return to cardiopulmonary bypass | 21 (2.6) | 9 (1.5) | .13 |
| Hemodynamic instability | 8 (1.0) | 5 (0.8) | .70 |
| Technical | 13 (1.6) | 3 (0.5) | .04 |
| Other | 2 (0.3) | 3 (0.5) | .66 |
| Red cell transfusion | .01 | ||
| 0 | 711 (88.9) | 582 (93.9) | |
| 1-2 | 71 (8.9) | 34 (5.5) | |
| ≥3 | 18 (2.2) | 4 (0.7) | |
| Hematocrit | |||
| Nadir on CPB | 27.0 [23.1, 30.4] | 26.7 [24.0, 29.7] | .82 |
| Before first RBC transfusion | 21.0 [19.0, 22.0] | 21.0 [19.0, 22.0] | .97 |
| Before second RBC transfusion | 20.5 [20.0, 22.0] | 21.0 [21.0, 23.0] | .09 |
| Intra-aortic balloon pump | 11 (1.4) | 9 (1.5) | 1.00 |
| Conventional ultrafiltration | 353 (44.1) | 89 (14.4) | <.001 |
| Ultrafiltration volume per kg, mL/Kg | 17.5 [10.5, 28.9] | 15.3 [11.5,24.0] | 0.20 |
| Cardiotomy suction | |||
| Not used | 0 (0.0) | 249 (40.2) | <.0001 |
| Used and stopped before protamine | 0 (0.0) | 371 (59.8) | <.0001 |
| Protamine dosing, mg | 250.0 [235.0, 300.0] | 250.0 [200.0, 300.0] | <.0001 |
| Method for calculating initial protamine dose | <.0001 | ||
| Fixed dose | 0 (0) | 2 (0.3) | |
| Heparin protamine titration | 464 (58.4) | 593 (95.8) | |
| Ratio dose of heparin given | 330 (41.6) | 24 (3.9) | |
| Protamine not given | 0 (0) | 0 (0) | |
| Other | 0 (0) | 0 (0) | |
| Non-RBC transfusion (amount in units) | |||
| In prime | |||
| Fresh-frozen plasma | 0 [0, 0] | 0 [0, 0] | .99 |
| During CPB | |||
| Platelets | 0 [0, 0] | 0 [0, 0] | .07 |
| Fresh-frozen plasma | 0 [0, 0] | 0 [0, 0] | .46 |
| Non-CPB | |||
| Platelets | 2 [1, 2] | 1 [1, 2] | .09 |
| Fresh-frozen plasma | 2 [2, 2] | 2 [2, 2] | .97 |
| Autotransfusion device used | 785 (98.1) | 605 (97.6) | .48 |
| Evidence of clot in circuit | 5 (0.6) | 4 (0.7) | 1.00 |
| Postoperative | |||
| Red cell transfusion | <.001 | ||
| 0 | 601 (75.1) | 560 (90.3) | |
| 1-2 | 146 (18.2) | 51 (8.2) | |
| ≥3 | 53 (6.6) | 9 (1.5) | |
| Reoperation for bleeding | 18 (2.2) | 5 (0.8) | .05 |
| Renal failure, % | 9 (1.1) | 7 (1.1) | .99 |
| Stroke, % | 10 (1.3) | 4 (0.7) | .24 |
| Intensive care unit, h | 66.0 [30.0, 99.2] | 31.4 [21.8, 54.9] | <.001 |
| Ventilation time, h | 5.3 [3.8, 9.3] | 4.0 [3.1, 5.6] | <.001 |
| Operative mortality | 4 (0.5) | 0 (0.0) | .21 |
STEMI, ST-Segment elevation myocardial infarction; CPB, cardiopulmonary bypass; PT/PTT, prothrombin time/partial thromboplastin time; NA, not available; RBC, red blood cell.