MPOG Cardiac Anesthesia Subcommittee Meeting
December 09, 2025
Agenda
Announcements
Measure Proposal: GLU-14-C
Ashan Grewal, University of Maryland
Unblinded Performance Review
GLU-06, GLU-07, GLU-08
TEMP-06, TEMP-07
BP-07
Introductions
• ASPIRE Quality Team
– Allison Janda, MD – MPOG Cardiac Anesthesia Subcommittee Chair
– Michael Mathis, MD – MPOG Director of Research
– Meridith Wade, MSN, RN – MPOG Cardiac Subcommittee Facilitator
– Mei Calabio, MSHI, RN – MPOG Cardiac Subcommittee Facilitator
• Cardiac Anesthesiology Representatives joining us from around the US!
Seeking Cardiac Subcommittee Vice-Chair
• Minimum 2-year term
• Help shape direction of Cardiac Subcommittee
• Measure performance review, new measure development, measure revision
• Identify and participate in research opportunities
• Work with Allison, Meridith, Mei and the MPOG team
• Be able to devote 2 - 4 hours per month to this role
• Cardiac Subcommittee Vice-Chair Description: here
• Interested faculty should submit their interest to MPOG QI Director (Nirav Shah) at
nirshah@med.umich.edu and MPOG Cardiac Subcommittee Chair (Allison Janda) at
ajanda@med.umich.edu by January 5th, 2026
Measure Review Process
• Review literature for given measure
topic and provide review using MPOG
Measure Review Template
• Present review of literature and
recommendations at Cardiac
Subcommittee meetings
• Reviewers names will be added to
measure specifications as well as
MPOG Measure Reviewer website
Upcoming Cardiac-Focused Measure Reviews
Measure Review Date Reviewers
GLU-06-C: Hyperglycemia Management June 2026 Josh Billings, Vanderbilt
GLU-07-C: Hypoglycemia Management June 2026 Rob Schonberger, Yale
GLU-08-C: Hyperglycemia Treatment June 2026 Josh Billings, Vanderbilt
Thank you in advance for ensuring MPOG Cardiac-specific measures remain relevant &
consistent with published recommendations!
Contact Allison with any questions: ajanda@med.umich.edu
Measure Updates
TRAN-05-C Coagulation Monitoring, Open Cardiac
• Description
– Percentage of adult patients undergoing open cardiac surgery who received a
transfusion and had coagulation testing performed (a TEG, ROTEM, platelet count,
PT/INR, PTT, or Fibrinogen) with administration of fresh frozen plasma, platelets,
cryoprecipitate, factor concentrates, or fibrinogen concentrates.
• Timing Anesthesia Start to Anesthesia End
• Success Criteria
– TEG, or ROTEM, platelet count, PT/INR, PTT, or Fibrinogen checked with
administration of fresh frozen plasma, platelets, cryoprecipitate, factor
concentrates, or fibrinogen concentrate.
Performance across MPOG Cardiac Sites, Past 12 mo.
New Glucose Measure Proposal
Dr. Ashan Grewal, University of Maryland
Current Cardiac Hyperglycemia Measures
• GLU-06-C: Percentage of adult patients undergoing an open cardiac procedure for
whom any intraoperative blood glucose value did not exceed 180 mg/dL.
• GLU-08-C: Percentage of adult patients undergoing open cardiac surgical
procedures for whom any blood glucose measure >/=180 mg/dL was either
treated with insulin or rechecked and found to be <180 mg/dL within 30 minutes.
GLU-14-C: Cardiac Hyperglycemia Successful Treatment Measure
• Description:
– Percentage of patients, ≥18 years age, who undergo open cardiac surgical
procedures under general anesthesia of 120 minutes case duration or longer for
whom the LAST blood glucose measure did not exceed 180 mg/dL.
– Note: open cardiac cases without ANY glucose values documented are flagged
• Timing:
– Start: Anesthesia Start
– End: Anesthesia End
GLU-14-C: Cardiac Hyperglycemia Successful Treatment Measure
• Concepts Queried:
– Glucose MPOG Concept ID's:
– 3361 POC - Glucose (Fingerstick) (mg/dL)
– 3362 POC - Glucose (Unspecified Source) (mg/dL)
– 3405 POC - Blood gas - Glucose (mg/dL)
– 5003 Formal lab - Glucose, Serum/Plasma (mg/dL)
– 5036 Formal lab - Blood gas - Glucose (mg/dL)
• Attribution:
– The provider signed in for the last 90 minutes of the case.
– In the event that two or more providers in the same role are signed in, both will
receive the feedback
GLU-14-C: Cardiac Hyperglycemia Successful Treatment Measure
• Inclusions:
– All patients, 18 years of age or older, both with and without diabetes, who
undergo open cardiac surgical procedures (as determined by Procedure Type:
Cardiac phenotype) under general anesthesia of 120 minutes duration or longer.
• Exclusions:
– ASA 6
– Organ harvest (CPT: 01990)
– Non-cardiac cases as defined as those cases not meeting criteria for the cardiac
case type phenotype
– Within the general cardiac case type phenotype, exclude:
– Transcatheter/Endovascular, EP/Cath groups and Other Cardiac
– Cases with age <18
Unblinded Data Review
Reminder
• Per the terms and conditions outlined during the registration process:
– A culture of openness and trust are critical to the development of such a collaborative effort to
improve quality; and a commitment for confidentiality is required to further the goals of ASPIRE.
• The following examples are to be considered privileged and confidential information
and should be discussed only within the confines of the Cardiac Subcommittee
Meeting.
– Any and all patient information.
– Any and all patient identifiers/information which are considered privileged and protected health
information as defined by current HIPAA laws.
– Any specific MPOG QI registry case information.
– Any information discussed regarding a specific site outcome.
– Any reference to a specific MPOG site result or analysis.
– All anesthesiology data presented including but not limited to outcome reports.
– Taking screenshots, pictures or videos of data slides is prohibited.
Site Participation
• All sites that perform >75 open cardiac procedures annually are presented on the
slides to follow
• This is a closed meeting: registration required to receive the Zoom link.
• Only those sites who have a participant on the cardiac subcommittee are unblinded
• Cardiac Anesthesia Champions were notified that unblinded data would be shared and
were given the opportunity to opt out
• No sites emailed us to express a desire to be excluded from this review
GLU-06-C - Hyperglycemia Management, Open Cardiac (>180 mg/ dL/>
10.00mmol/L)
• Description:
– Percentage of adult patients undergoing an open cardiac procedure for
whom any intraoperative blood glucose value did not exceed 180 mg/dL.
• Timing:
– Anesthesia Start to 30 minutes after Anesthesia End
• Success Criteria:
– The highest blood glucose was maintained at </=180 mg/dL, or
– Glucose >180 mg/dL that was rechecked within 30-minutes and found to be
≤ 180 mg/dL.
GLU-06-C - Hyperglycemia Management, Open Cardiac (>180 mg/ dL/>
10.00mmol/L) Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by
Procedure Type: Cardiac value code: 1).
• Exclusions:
– Age < 18 years
– ASA 6 (Organ Procurement - CPT: 01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases
(determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)
GLU-07-C - Hypoglycemia Management, Open Cardiac
(<70mg/dL/<3.885mmol/L)
• Description:
– Percentage of adult patients, undergoing open cardiac surgery with any
intraoperative blood glucose value < 70 mg/dL.
• Timing:
– Anesthesia Start to 15 minutes after Anesthesia End
• Success Criteria:
– The lowest blood glucose was maintained at >/=70 mg/dL, or
– Glucose <70 mg/dL that was rechecked within 15 minutes and found to be
>/=70 mg/dL.
GLU-07-C - Hypoglycemia Management, Open Cardiac
(<70mg/dL/<3.885mmol/L) Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by
Procedure Type: Cardiac value code: 1).
• Exclusions:
– Age < 18 years
– ASA 6 (Organ Procurement - CPT: 01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases
(determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)
GLU-06-C vs. GLU-07-C Performance
GLU-08-C - Hyperglycemia Treatment, Open Cardiac (>180 mg/dL/ >10.00
mmol/L)
• Description:
– Percentage of adult patients undergoing open cardiac surgical procedures for
whom any blood glucose measure >/=180 mg/dL was either treated with
insulin or rechecked and found to be <180 mg/dL within 30 minutes.
• Timing:
– Anesthesia Start to 30 minutes after Anesthesia End
• Success Criteria:
For any blood glucose ≥180 mg/dL, at least one of the following interventions are
documented:
– Treatment with insulin within 30 minutes, or
– Glucose rechecked and found to be below 180 mg/dL within 30 minutes
GLU-08-C - Hyperglycemia Treatment, Open Cardiac (>180 mg/dL/>10.00
mmol/L) Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by
Procedure Type: Cardiac value code: 1).
• Exclusions:
– Age < 18 years
– ASA 6 (Organ Procurement - CPT: 01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases
(determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)
GLU-06-C vs. GLU-08-C Performance
TEMP-06-C - Hypothermia Avoidance, Cardiac
• Description:
– Percentage of adult patients undergoing an open cardiac procedure for
whom any core temperature at the end of the case < 35.5° C (or 95.9° F).
• Timing:
Measure Start:
1. Cardiopulmonary Bypass Initiated (ID:50410), if not present,
2. Cardiopulmonary Bypass Start Phenotype
Measure End:
1. 30 minutes after Anesthesia End
*For cases without bypass: Anesthesia End to 30 minutes after Anesthesia End
TEMP-06-C - Hypothermia Avoidance, Cardiac Considerations
• Success Criteria:
– Last non-artifact body temperature ≥ 35.5 degrees Celsius (or 95.9 degrees
Fahrenheit) at Anesthesia End (Prioritizes core temperature measurements)
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by
Procedure Type: Cardiac value code: 1)
• Exclusions:
– Age <18 years
– ASA 6 including Organ Procurement (CPT: 01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases
(determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)
TEMP-06-C: Breakdown of Flagged cases by Temp route
TEMP-07-C - Hyperthermia Avoidance, Cardiac
• Description:
– Percentage of adult patients undergoing an open cardiac procedure for
whom core temperature was >37.5° C (99.5° F) for more than 5 consecutive
minutes while on cardiopulmonary bypass.
• Timing:
Measure Start:
– Cardiopulmonary Bypass Initiated (ID:50410), if not present,
– Cardiopulmonary Bypass Start Phenotype
Measure End:
– Cardiopulmonary Bypass Terminated (ID: 50409), if not present,
– Cardiopulmonary Bypass End Phenotype. If not present,
– Anesthesia End
TEMP-07-C - Hyperthermia Avoidance, Cardiac Considerations
• Success Criteria:
– Less than 5 consecutive minutes of non-artifact body temperature > 37.5
degrees Celsius between cardiopulmonary bypass start and cardiopulmonary
bypass end. (Temperature hierarchy listed under “Other Measure Details”).
– (Prioritizes core temperature measurements)
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures as determined by
Procedure Type: Cardiac value code: 1 and requiring cardiopulmonary bypass
TEMP-07-C - Hyperthermia Avoidance, Cardiac Considerations
• Exclusions:
– Age <18 years
– ASA 6 including Organ Procurement (CPT: 01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases
(determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)
– Open Cardiac cases performed without bypass (determined by Procedure
Type: Cardiac value code: 1, without any bypass start or bypass end
concepts)
TEMP-07-C: Breakdown by Flagged Reason
BP-07-C - Low MAP Avoidance < 55 during induction, Open Cardiac
• Description:
– Percentage of adult patients undergoing open cardiac procedures where
hypotension for greater than 5 minutes (defined as MAP < 55 mmHg) was
avoided during the induction period until surgery start.
• Timing:
– Anesthesia Start to Surgery Start
• Success Criteria:
– MAP <55 mmHG that does not exceed cumulative time of 5 minutes during
induction OR
– MAP ≥55 mmHG throughout induction period.
BP-07-C - Low MAP Avoidance < 55 during induction, Open Cardiac
Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by
Procedure Type: Cardiac value code: 1)
• Exclusions:
– Age < 18 years
– ASA 6 including Organ Procurement (CPT:01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac
Phenotype by the Procedure Type: Cardiac (value codes: 0, 2, 3, and 4)
– Lung Transplants
BP-07-C: Breakdown of Flagged Cases
