J Extra Corpor Technol 2025 , 57 , 9 – 13 Ó The Author ( s ), published by EDP Sciences , 2025 https :// doi . org / 10.1051 / ject / 2024033
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Evaluating the need for magnesium administration following cardioplegic arrest with del Nido cardioplegia solution
Carrie Whittaker Striker ( DHEd , MPS , CCP , FPP ) 1 ,* and James A . Reagor ( MPS , CCP , FPP ) 2
1 Department of Cardiovascular Perfusion , Children ’ s Wisconsin , Milwaukee , Wisconsin , USA 2 Department of Cardiovascular Perfusion , Cincinnati Children ’ s Hospital Medical Center and Department of Pediatrics ,
University of Cincinnati College of Medicine , Cincinnati , Ohio , USA Received 19 April 2024 , Accepted 9 September 2024
Abstract – Background : del Nido cardioplegia ( dNC ) solution is widely used in pediatric and congenital cardiac surgery . In 2014 , Cincinnati Children ’ s Hospital Medical Center ( CCHMC ) changed from Mee cardioplegic solution to dNC . Since Mee solution does not contain magnesium , magnesium was administrated post cross-clamp removal , at a dose of 25 mg / kg up to 1 g , to abate hypomagnesemia . This practice remained in place with the use of dNC . We postulated that patients may experience hypermagnesemia under this protocol . Methods : To determine if exogenous magnesium is necessary post-clamp removal in our practice , a study examining serum magnesium levels during cardiopulmonary bypass ( CPB ) was completed from January 2022 through October 2023 ( IRB # 2021-0816 ). One hundred patients undergoing CPB with cross-clamp , ranging from infants to adults , were consented . Two magnesium samples were collected . Draw 1 ( D1 ) was collected post cardioplegia administration and 30 min prior to cross-clamp removal . Draw 2 ( D2 ) was collected post-cross-clamp removal and 10 ± 2 min following magnesium administration . Results : Both samples demonstrated magnesium levels > 1.6 mg / dL or higher ( normal magnesium range at CCHMC , 1.6 – 2.6 mg / dL ). A Wilcoxon rank sum test demonstrated statistical significance for D1 , comparing the number of samples that fell above 2.6 mg / dL vs . those that fell within the normal range ( p < 0.001 ). D2 demonstrated values above the normal range for all but one sample , which does not satisfy the criteria of the Wilcoxon rank sum test for demonstrating significance ( p = 0.089 ); however , ninety-nine samples displayed hypermagnesemia . Conclusion : This study demonstrates that exogenous magnesium administration may not be necessary in the setting of our practice at CCHMC and dNC cardioplegic arrest .
Key words : del Nido , Cardioplegia , Magnesium , Hypomagnesemia , Arrhythmia .
Introduction
The cardioplegia solution for many pediatric and congenital cardiac surgical programs is del Nido Cardioplegia ( dNC ). Compared to other cardioplegic solutions , dNC accommodates longer ischemic times between dosing allowing the surgeon increased intervals of uninterrupted operating time [ 1 ]. At Cincinnati Children ’ s Hospital Medical Center ( CCHMC ), dNC has been used since 2014 , replacing Mee solution . Unlike dNC ( Table 1 ), Mee solution ( Table 2 ) does not contain magnesium hence , the institutional practice was to administer magnesium after cross-clamp removal at a dose of 25 mg / kg to a maximum dose of 1 g .
Since the transition to dNC cardioplegia , the administration of magnesium post-cross-clamp removal remained in place . To continuously interrogate our clinical processes , specifically following major practice changes , a study was designed to
* Corresponding author : cstriker @ childrenswi . org evaluate serum magnesium levels on CPB . We hypothesized that magnesium levels , under CCHMC ’ s current protocol , may result in magnesium levels at or above physiologic levels . This study examined magnesium levels prior to and after crossclamp removal for one hundred congenital cardiac patients undergoing cardioplegic arrest with dNC and magnesium administration from January 2022 through October 2023 at CCHMC .
Materials and methods
“ Magnesium Administration After Cardioplegic Arrest with Del Nido Cardioplegia ” ( IRB # 2021-0816 ) was approved in January 2022 by the CCHMC institutional review board . This study measured serum magnesium levels pre and postcross-clamp removal for patients undergoing cardiopulmonary bypass ( CPB ) in dNC arrest and magnesium administration . Patients were recruited based on the cardiac surgical schedule
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