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Quick Reference: Custodiol Cardioplegia

  1. Custodiol HTK must be stored refrigerated at 2-10°C. 
  2. The standard ratio cardioplegia set will be used with the inflow line to from oxygenator clamped. The bridge should be open and the cardioplegia circuit primed.
  3. A hemoconcentrator should be placed in the CPB circuit at the time of setup whenever Custodial HTK is being used.
  4. Custodiol HTK will be delivered at 3-4 Degrees Celsius, 20 ml/kg to a maximum of 2 liters for the initial dose; subsequent doses are delivered at 3-4 Degrees Celsius, 10ml/kg to a maximum of 1 liter. The delivery pressure for Custodiol is different from blood based cardioplegia due to its low viscosity, which is similar to sterile water. 
  5. If  possible, scavenge the Custodiol cardioplegia delivered to the heart into the cell saver or waste suction. One option is to Y the LV vent line after the roller pump so the crystalloid can be directed to the cell saver.
  6. Initially Custodiol will be delivered at a line pressure of approximately 125 mmHg with the long plegia needle until an electrical arrest of the heart is achieved. The line pressure will then be reduced to approximately 75 mmHg for the remainder of the dose
  7. Ensure proper venous drainage (VAVD is recommended) and avoid distending the heart which can lead to washout.  If washout occurs, the need for redosing will be more frequent.
  8. The perfusionist will notify the Surgeon at 90 minutes after the initial dose. An additional dose of 10ml/kg should be given if electrical activity is evident or before 120 minutes of myocardial ischemia has passed.
  9. Continuous hemoconcentration and ZBUF (Zero-Balance UltraFiltration) will need to be performed on all patients receiving Custodiol. After removing the crystalloid load, ZBUF will need to be performed using at least, 1 liter of 0.9% NaCl with 50ml of Sodium Bicarbonate added to it. 

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