Quick Reference: Cold Agglutinins

Unexpected cold agglutination is normally only observed in
the cardioplegia administration set. 
These are three basic options to handle Cold Agglutinins as follows:

1. Continuous warm retrograde cardioplegia: keeping
   both the body and plegia temperatures at 35 degrees C.   Continuous antegrade can be an option.
2. Warm crystalloid wash-out followed by cold
   crystalloid cardioplegia: Most effective if bicaval cannulation is used. 
3. If CABG only:  Off pump or warm beating heart surgery with no cardioplegic arrest.

Procedure for warm washout / cold crystalloid:

1. Clamp and remove ¼” line from raceway and put
   tape around the 1/8” line so it doesn’t creep into the raceway.  Keep in mind that the flow will be half of
   what is indicated on the flow meter.
2. 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.
3. Administer warm crystalloid until the fluid from
   the atrium is clear.
4. Administer cold crystalloid until no electrical
   activity is seen.
5. Give cold crystalloid intermittent doses as
   usual.
6. Prior to cross clamp removal, give a final 37
   degree dose to increase the myocardial temperature.
7. If you know what the critical temperature is,
   the cardioplegia can be administered at a slightly higher temperature.