Effects of original crystalloid cardioplegia followed by additional blood cardioplegia: treatments for prolonged cardiac arrest.

Purpose: The efficacy of combination treatment of original cold crystalloid cardioplegia (SHA solution; St. Thomas + Histidine + ATP + oxygen) and additional blood cardioplegia was studied in patients who required cardiac arrest time of 120 minutes or longer.

Methods: One hundred and thirty-six patients were included in this study. Patients were divided into two groups according to the cardiac arrest time: S group (cardiac arrest time: 120-149 minutes, n = 81); L group (150-180 minutes, n = 55). Just after cross-clamping of the ascending aorta, 800 ml of SHA solution was infused in an antegrade fashion. Cold-blood cardioplegia was initiated after two hours of cardiac arrest.

Results: Six (4%) of the 136 patients died after surgery, 3 in each group. Two critical patients with ischemic cardiomyopathy died of cardiac failure after coronary artery bypass grafting (CABG), and 4 died of noncardiac morbidity. The mean value of postoperative maximum creatine phosphokinase-MB (CPK-MB) in dead patients was 47 IU/L in the S group and 75 IU/L in the L group. The peak CPK-MB values exceeded 100 IU/L in one out of 6 patients who died after surgery.

Conclusions: Combination treatment using original SHA solution and additional blood cardioplegia was effective in patients who required prolonged cardiac arrest.