Microplegia Protocol Results in $80,000 Savings for 450 Case Program

JANUARY 2008

A Comparison of Cardioplegia Protocols
	4:1 Cardioplegia	Microplegia
Formula	Two bags per case Tham 200ml D5 with 0.2% NaCl 550ml KCl 60meq (high K) OR KCl 20meq (low K) CPD 50ml	One bag per case 100meq KCl (50ml) 0.45%NaCl (145 ml) 2.5 MgSO4 (5ml)
Pharmacy impact	Pharmacy mixed $79.90 ⁄ bag	Purchased from outside supplier Pharmacy adds MgSO4 day of case KCl ⁄ NaCl solution has longer shelf life
Other cost impact		Less anesthesia insulin Less lab testing

Changing from 4:1 cardioplegia to microplegia saves Excela Health’s Westmoreland Hospital $80,000 annually. The hospital performs 450 heart surgeries per year.

A change in cardioplegia protocol at Excela Health’s Westmoreland Hospital in Greensburg, Pennsylvania is saving the hospital $80,000 annually on its 450 cardiac surgery cases. The perfusion team switched from a 4:1 cardioplegia protocol to a microplegia protocol using the Master ⁄ Follower capability of its Terumo^® Advanced Perfusion System 1. The financial analysis, conducted by the hospital’s pharmacy department, compared costs associated with both protocols, including the cost of the cardioplegia drugs and solutions, insulin use by anesthesia, lab tests, and pharmacy labor.

Jim Patterson, CCP, Chief of Perfusion Services, believes that the microplegia protocol has also enhanced patient care. “Now serum potassiums on pump are more tightly controlled and rarely go above 5.8 meq ⁄ dl. And since we now give one tenth the crystalloid that we gave with the 4:1, there’s less chance for myocardial edema and potentially better function coming off bypass.”

Shortly after Jim started as Chief at Westmoreland, the surgeons directed the perfusion team to develop a microplegia protocol using Terumo System 1’s Master ⁄ Follower feature. Jim continued to use the 4:1 tubing set that was delivered with the hospital’s custom tubing pack; the 1 ⁄ 4” line in the master pump for blood and the 1 ⁄ 16” line in the follower pump for crystalloid.

Jim calculated that he would need to dilute the potassium to 0.5meq ⁄ ml and run the follower pump at 4% of the master pump speed to deliver an arrest dose of 20meq of potassium. He could then adjust the follower pump from 0– 8% of the master pump speed to deliver subsequent doses maintaining arrest or warm blood prior to cross clamp removal.

The new protocol allows the perfusion team to reduce the amount of cardioplegia solution from two bags per case to one and do less lab testing. Anesthesia uses less insulin. And the new formula has a longer shelf life.

According to Jim, “While we have yet to authenticate differences in clinical outcomes with this new protocol, anecdotally, we are seeing less of a need for pharmacological support coming off bypass. The change in protocol also falls in line with all our other efforts to reduce our significantly low transfusion rates.”