Quick Reference: Cold Agglutinins

Unexpected cold agglutination is normally only observed in the cardioplegia administration set. There are two basic options for cardioplegia as follows:

1. Continuous warm retrograde or antegrade cardioplegia: keeping both the body and cardioplegia temperatures at 35 degrees C.   
2. Warm crystalloid wash-out followed by cold crystalloid cardioplegia: Most effective if bicaval cannulation is used.  

• If you are using a ratio Cardioplegia set: Clamp the ¼” line from the oxygenator and open the bridge.
• You need to be aware of your of KCL concentration since you will not be diluting the crytalloid with blood. A low KCL cardioplegia solution (Plegisol or Custidiol HTK) should be used.
• Warm the cardioplegia to 37 degrees C, and flush out the blood in the system.  
• A sump should be placed in the right atrium to collect the effluent (do not return to pump).
• Administer warm crystalloid until the fluid from the atrium is clear.
• Switch to cold crystalloid until no electrical activity is seen.
• Give cold crystalloid intermittent doses as usual.
• Prior to cross clamp removal, give a final 37 degree C dose to increase the myocardial temperature.