MPOG Cardiac Anesthesia Subcommittee Meeting
June 30th, 2025
Agenda
• Introduction & announcements
• Measure Update:
– ABX-03: Antibiotic Re-dosing, Open Cardiac
• Preliminary Data for New Measure
– BP-07-C: Hypotension Avoidance (MAP < 55 mmHg), Induction, Open Cardiac
– TRAN-05-C: Coagulation Monitoring
– TRAN-06-C: Balanced Transfusion
• Summary and next steps
Introductions
• ASPIRE Quality Team
– Allison Janda, MD – MPOG Cardiac Anesthesia Subcommittee Chair
– Michael Mathis, MD – MPOG Director of Research
– Henrietta Addo, MSN, RN – MPOG Cardiac Subcommittee Facilitator
• Cardiac Anesthesiology Representatives joining us from around the US!
Seeking Cardiac Subcommittee Vice-Chair
• 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, Henrie, 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
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
TEMP-06-C: Hypothermia Avoidance March 2025 Mariya Geube, Cleveland Clinic
TEMP-07-C: Hyperthermia Avoidance March 2025 Ashan Grewal, UMaryland
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
Thank you,
Dr. Geube and
Dr. Grewal!
Measure Updates
ABX-03-C: Antibiotic Re-dosing, Open Cardiac Procedures
• Description:
– Percentage of adult patients undergoing open cardiac procedure with an antibiotic
redose initiated within four hours after initial antibiotic administration (cephalosporins
only).
• Timing:
– 120 minutes prior to Anesthesia Start through Surgery End. If Surgery End is not
available, Anesthesia End
• Success Criteria:
– Documentation of cephalosporin redose within 165-255 minutes after each
cephalosporin administration
• Upcoming update:
– Exclusion criteria: cases where surgery end time occurs before re-dose is due (less
than 4 hours and 15 minutes after cephalosporin dose) AND no re-dose was
administered
ABX-03-C Performance Across MPOG
Preliminary Measures
BP-07-C: Hypotension Avoidance (MAP < 55 mmHg), Induction,
Open Cardiac
• Description:
– Percentage of adult patients undergoing open cardiac procedures where
hypotension (defined as MAP < 55 mmHg) was avoided during the induction
period until surgery start.
• Timing:
– Anesthesia Start through Surgery Start
• Inclusions:
– Adult patients undergoing open cardiac procedures (determined by Procedure
Type: Cardiac value code: 1)
• Success Criteria:
– MAP < 55 mmHg that does not exceed cumulative time of 5 minutes throughout
induction period until surgery start
BP-07-C: Hypotension Avoidance (MAP < 55 mmHg),
Induction, Open Cardiac
• Exclusions:
– Age < 18
– ASA 6 including Organ Procurement (CPT:01990)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases as
defined by the Procedure Type: Cardiac phenotype (value codes: 0, 2, 3, and 4)
– Lung transplants
Discussion
• Any questions or comments with this specification?
– Any additions to the exclusion criteria?
– Expand threshold to 10 minutes instead of 5?
• Any concerns with moving forward with BP-07-C?
• Should we move this to a vote?
– Yes
– No
TRAN-05-C: Coagulation Monitoring
Description:
– Percentage of adult patients undergoing open cardiac surgery who received
transfusion and had a TEG or ROTEM checked with administration of blood and/or
blood components
Timing:
– Anesthesia Start through Anesthesia End
Inclusions:
– Adult patients undergoing open cardiac procedures (determined by Procedure
Type: Cardiac value code: 1)
Success Criteria:
– TEG or ROTEM checked with administration of blood and blood components
TRAN-05-C: Coagulation Monitoring
Exclusions:
– Age < 18
– ASA 6 including Organ Procurement (CPT:01990)
– Patients who did not receive a transfusion
Transfusion defined as:
– Packed Red Blood Cells
– Whole Blood
– Fresh Frozen Plasma
– Cryoprecipitate
– Platelets
– Categorized Note - Blood Products
– Cases are excluded with only administration of autologous or salvaged blood
– Cases are included if autologous or salvaged blood is administered with any of the
above transfusions
Discussion
• Any questions or comments with this specification?
– Any ROTEM/TEG between anesthesia start and end or on the day of surgery?
– Considerations for how these labs are charted across all sites
• Any concerns with moving forward with TRAN-05-C?
• Vote?
– Yes, publish this measure
– No, give sites time to improve their mapping?
TRAN-06-C: Balanced Transfusion
Description:
– Percentage of adult patients undergoing open cardiac surgery who received
transfusion and a 1:1:1 ratio of blood products was administered
Timing:
– Anesthesia Start through Anesthesia End
Inclusions:
– Adult patients undergoing open cardiac procedures (determined by Procedure
Type: Cardiac value code: 1)
Success Criteria:
– 1:1:1 ratio of red blood cells to FFP to platelets were administered
TRAN-06-C: Balanced Transfusion
Questions/Concerns:
– Is a 1:1:1 ratio clinically superior to a laboratory-driven transfusion strategy?
Preliminary Data:
Next Steps - New Measure Topics?
• Current cardiac measures:
– Antibiotic timing, re-dosing, selection, composite
– AKI avoidance
– Fluids - minimizing colloid use (dev by general QC)
– Glucose management
– Temperature management
• Previous measure topics proposed include:
– Neuromuscular blockade reversal
– Pulmonary complication avoidance (extubation in OR or within 6h)
Next Steps
• Open to all anesthesiologists or those interested in improving cardiothoracic
measures
– Do not have to practice at an active MPOG institution
• Meeting Schedule
– June 2025
– November 2025
– February 2026
– June 2026
– November 2026
• Thank you for using the forum for discussion between meetings
