Current Practice of Calcium Use During Cardiopulmonary Bypass Weaning: Results of an International Survey

Ломиворотов, В. В.; Guvakov, Dmitri; Belletti, Alessandro; Boboshko, Vladimir; Shmyrev, Vladimir; Kunst, Gudrun; Stoppe, Christian; Аксельрод, Б. А.; Каменщиков, Н. О.; Efremov, Sergey; Chernyavskiy, Alexander; Landoni, Giovanni

doi:10.1053/j.jvca.2020.02.010

Cited by 12 publications

(7 citation statements)

References 29 publications

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“…In our hospital, calcium gluconate is administered after weaning from cardiopulmonary bypass as is common practice in cardiac surgery. 32 Calcium is administered independent of preoperative use of cardiovascular medication and the anticipated consequence of calcium administration is a positive inotropic effect. Therefore, we consider it unlikely that intraoperative calcium administration is responsible for the finding that preoperative CCB use is a risk factor for a decline in RV function.…”

Section: Discussionmentioning

confidence: 99%

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Identifying risk factors for perioperative decline in right ventricular performance in cardiac surgery patients: a prospective observational study in a tertiary care hospital

et al. 2023

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ObjectivesImpaired right ventricular (RV) function after cardiac surgery is associated with morbidity and long-term mortality. The purpose of this study was to identify factors that play a role in the development of RV dysfunction in the perioperative cardiac surgery setting.DesignWe performed a prospective, observational, single centre study. Over a 2-year period, baseline and perioperative characteristics were recorded. For analysis, subjects were divided into three groups: patients with a ≥3% absolute increase in postoperative RV ejection fraction (RVEF) in comparison to baseline (RVEF+), patients with a ≥3% absolute decrease in RVEF (RVEF−) and patients with a <3% absolute change in RVEF (RVEF=).SettingTertiary care hospital in the Netherlands.ParticipantsWe included all cardiac surgery patients ≥18 years of age equipped with a pulmonary artery catheter and admitted to the ICU in 2015–2016. There were no exclusion criteria. A total number of 267 patients were included (65.5% men).Outcome measuresRisk factors for a perioperative decline in RV function.ResultsA reduction in RVEF was observed in 40% of patients. In multivariate analysis, patients with RVEF− were compared with patients with RVEF= (first-mentioned OR) and RVEF+ (second-mentioned OR). Preoperative use of calcium channel blocker (CCB) (OR 3.06, 95% CI 1.24 to 7.54/OR 2.73, 95% CI 1.21 to 6.16 (both p=0.015)), intraoperative fluid balance (FB) (OR 1.45, 95% CI 1.02 to 2.06 (p=0.039)/OR 1.09, 95% CI 0.80 to 1.49 (p=0.575)) and baseline RVEF (OR 1.22; 95% CI 1.14 to 1.30/OR 1.27, 95% CI 1.19 to 1.35 (both p<0.001)) were identified as independent risk factors for a decline in RVEF during surgery.ConclusionApart from the impact of the perioperative FB, preoperative use of a CCB as a risk factor for perioperative reduction in RVEF is the most prominent new finding of this study.

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Section: Discussionmentioning

confidence: 99%

“…In our hospital, calcium gluconate is administered after weaning from cardiopulmonary bypass as is common practice in cardiac surgery 32. Calcium is administered independent of preoperative use of cardiovascular medication and the anticipated consequence of calcium administration is a positive inotropic effect.…”

Section: Discussionmentioning

confidence: 99%

Identifying risk factors for perioperative decline in right ventricular performance in cardiac surgery patients: a prospective observational study in a tertiary care hospital

et al. 2023

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“…Calcium administration has improved cardiac output and the mean arterial pressure in several studies. A study showed an increase in cardiac index, stroke volume, and mean blood pressure after administering 1.5 mg/kg/min of calcium [ 5 , 38 , 39 ]. The evidence supporting the beneficial effects of calcium (such as increasing the variables mentioned above) is limited in the case of Vasoplegia and moderate contractility reduction [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables in infants undergoing open-heart surgery

et al. 2022

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Background The incidence of complications after heart surgery is a critical factor in disability, deaths, lengthening hospital stays, and increasing treatment costs. The metabolic balance of certain hormones and electrolytes is necessary for proper cardiac function. In children, various biochemical conditions may cause calcium depletion during heart surgery. The purpose of this study was to determine the effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables and clinical outcomes in infants undergoing open-heart surgery. This study was conducted at Rajaie Cardiovascular Medical and Research Center in 2021 using a controlled randomized clinical trial. A total of 60 patients with open-heart surgery weighing up to 10 kg were included in the study. The first group received an intravenous injection of calcium gluconate 20 min after opening the aortic clamp, and the second group was monitored as a control group. Data collection tools included checklists containing demographics, surgical information, and intensive care unit measures. Results The Chi-square test or Fisher's exact test showed that the frequency distribution of gender, blood group, Rhesus factor (RH), and clinical diagnosis in the two groups of intervention and control was not statistically significant (p < 0.05). The mean and standard deviation of Ejection Fraction (EF) changes (before and after) were 13.27 ± 9.16 in the intervention group and 8.31 ± 9.80 in the control group (p = 0.065). The results of two-way repeated measures ANOVA showed that mean systolic blood pressure (p = 0.030), mean diastolic blood pressure (p = 0.021), mean heart rate (p = 0.025), mean arterial pressure (p = 0.020), mean pH (p < 0.001), and mean hemoglobin (p = 0.018) in the intervention, and control groups were statistically significant. Conclusions In the present study, unlike systolic pressure, mean diastolic blood pressure decreased, and mean arterial pressure increased significantly. As a result, the slope of changes during the study period was different in the intervention and control groups.

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“…However, none of the existing small trials have been powered to detect differences in clinical outcomes. Despite this fact a recent survey on perioperative calcium use in cardiac surgery showed a high rate use during CPB weaning in daily practice worldwide [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to an international survey, calcium salts are widely used (in 71% of centers) to improve hemodynamics during CPB termination [ 10 ]. The rationale of calcium administration are derived from several studies that reported transient improvement of cardiac output and mean arterial pressure [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Calcium administration In patients undergoing CardiAc suRgery under cardiopulmonary bypasS (ICARUS trial): Rationale and design of a randomized controlled trial

Ломиворотов

Ponomarev

Boboshko

et al. 2021

Contemporary Clinical Trials Communications

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Introduction Weaning from cardiopulmonary bypass (CPB) is a critical step of any cardiac surgical procedure and often requires pharmacologic intervention. Calcium ions are pivotal elements for the excitation-contraction coupling process of cardiac myocytes. Thus, calcium administration might be helpful during weaning from CPB. Methods We describe a multicenter, placebo-controlled, double blind randomized clinical trial to assess the effect of calcium chloride on the need for inotropic support among adult patients during weaning from CPB. The experimental group (409 patients) will receive 15 mg/kg of calcium chloride. The control group (409 patients) will receive an equivalent volume of 0.9% sodium chloride. Both drugs will be administered intravenously as a bolus at the beginning of weaning from CPB. Results The primary outcome will be the need for inotropic support between termination of CPB and completion of surgery. Secondary outcomes will be: duration of inotropic support, vasoactive-inotropic score 30 min after transfer to intensive care unit and on postoperative day 1, plasma alpha-amylase on postoperative day 1, plasma Ca 2+ concentration immediately before and 10–15 min after calcium chloride administration, non-fatal myocardial infarction, blood loss on postoperative day 1, need for transfusion of red blood cells, signs of myocardial ischemia on electrocardiogram after arrival to intensive care unit, all-cause mortality at 30 days or during hospital stay if this is longer than 30 days. Discussion This trial is designed to assess whether intravenous calcium chloride administration could reduce the need for inotropic support after cardiopulmonary bypass weaning among adults undergoing cardiac surgery.

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Current Practice of Calcium Use During Cardiopulmonary Bypass Weaning: Results of an International Survey

Cited by 12 publications

References 29 publications

Identifying risk factors for perioperative decline in right ventricular performance in cardiac surgery patients: a prospective observational study in a tertiary care hospital

Identifying risk factors for perioperative decline in right ventricular performance in cardiac surgery patients: a prospective observational study in a tertiary care hospital

The effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables in infants undergoing open-heart surgery

Calcium administration In patients undergoing CardiAc suRgery under cardiopulmonary bypasS (ICARUS trial): Rationale and design of a randomized controlled trial

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