title: A comparison of 250 and 500 mL of terminal warm blood cardioplegia after global myocardial ischemia: a prospective randomized study.
abstract: BACKGROUND
  Controlled reperfusion with terminal warm blood cardioplegia (TWBC) improves myocardial performance after global ischemia. However, the optimum volume required is unknown.
  
  
  METHODS
  Fifty patients undergoing elective coronary artery bypass graft surgery were prospectively randomized to receive either 250 or 500 mL of TWBC. During TWBC delivery, and for 10 minutes after cross-clamp removal, samples were taken from the aorta and coronary sinus to measure the hydrogen ion, lactate, and oxygen content.
  
  
  RESULTS
  At the end of TWBC delivery, the 500 mL group had significantly less hydrogen ion washout (p = 0.006) compared with the 250 mL group. Also, more hydrogen ions (p = 0.02) and lactate (p = 0.02) had been washed out during the entire period of TWBC delivery in the 500 mL group compared with the 250 mL, indicating better metabolic recovery. By 4 minutes after aortic cross-clamp removal, hydrogen ion and lactate washout, as well as oxygen extraction was similar in the two groups. However, the time to return to regular mechanical activity was prolonged in the 500 mL group, 5.8 (3) versus 4.6 (3) minutes in the 250 mL group (p = 0.05). Though there was no difference in postoperative Troponin T levels, eight patients in the 500 mL group versus four in the 250 mL group required ionotropic support (p = 0.1).
  
  
  CONCLUSIONS
  A total of 500 mL of hotshot achieves a better metabolic state after hotshot delivery. However, there is no clinical benefit or improvement in the postoperative Troponin T release suggesting that in a short ischemic time, 500 mL TWCB has a limited clinical benefit.
authors.affiliation: Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom. akowuah@yahoo.com
authors.forename: Enoch F
authors.initials: EF
authors.lastname: Akowuah
authors.forename: Imran
authors.initials: I
authors.lastname: Riaz
authors.forename: Vivek
authors.initials: V
authors.lastname: Shrivastava
authors.forename: Patrick
authors.initials: P
authors.lastname: Onyeaka
authors.forename: Graham
authors.initials: G
authors.lastname: Cooper
mesh_terms: D002314:Cardioplegic Solutions / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006321:Heart / Q000502:physiology*; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology* / Q000601:surgery*; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000378:metabolism; D011446:Prospective Studies; D013997:Time Factors; D020107:Troponin T / Q000378:metabolism
chemical_list: D002314:Cardioplegic Solutions; D020107:Troponin T