Custodial: Myocardial Protection

“Every practice regarding cardioplegia that works in neonates- works on adults as well- however it is NOT applicable vice-versa”


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Editor’s Note:

Clearly we as perfusionists are all about patient protection at every tissue level:  The brain, the kidneys, the central nervous system, and obviously the heart (myocardium).

My observation is the following on a routine case involving CPB…

  • On CPB- establish Q- cool or drift-…
  • XC On
  • High dose K+ cardioplegia delivered at usually a concentration of 64 MEQ KCL/L @ 5-7 degrees C x 1,000 cc’s)
  • Intermittent doses as each distal is done (less than 20 minutes seems the standard accepted ischemic time) Low dose K @ 500 or so cc’s
  • Maybe a “hot shot of low dose “K” or pure blood to rewarm the heart and flush out residual pools of K+ after the last distal.
  • Dump in 100 mg of lidocaine- as the XC comes off and it’s a done deal.

It may sound simplistic- but having done hearts at 34+ institutions- it is what it is- and it hasn’t varied much.  You can make it sound more complicated, but the bottom line-that formula is pretty universal.

We are not mechanics, perfusion is definitely an art in regards to managing a pump-run, but in the realest sense- we go with the flow regarding accepted practice and that is something hard to change.

Will the pulse that drives this universal regimen change?  I doubt it.

So here is a pretty interesting discussion regarding what a a lot of us aren’t thinking about once we get happy and see a flat line 🙂

Follow THIS LINK for a pretty enlightening Myocardial Protection Video:

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Custodial Cardioplegia & Myocardial Preservation


Click image to view presentation

As the Editor of, I suppose the expectation is that I am at least up to date and fully informed when it comes to most perfusion techniques.

Custodial Cardioplegia is an unknown and unfamiliar concept to me- so follow along as we learn this together.

The following post will discuss how Custodial Cardioplegia enhances myocardial preservation, and the optimal circumstances on how to employ this technique

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A Refresher Course on Organic Chemistry 101



Heart Protection 101



Basic O Chem


3 reduction of ATP to 2 after X Clamp

Reduction of ATP to 2 after X Clamp


4 Reduction of ATP increse of Lactic Acid

Reduction of ATP & increase of Lactic Acid


5 Lactate prododuction

Lactate production


6 Stone Heart

Stone Heart



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Figure 2



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10 Decrease in ATP

Decease in ATP


12 Recovery of atp lasts for days not minutes

Recovery of ATP lasts for days not minutes


13 Decrease in pH in myocardium

Critical pH for patient is 7.0


14 Critical pH is 7.0

Critical  pH for myocardium is 6.0

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