Cardiac Anesthesia Subcommittee Minutes
June 30, 2025
2:00pm – 3:00pm EST
Zoom
Henrietta Addo, MPOG
Mike Mathis, MPOG
Tammy Atwood, Henry Ford
Michael McCaughan, Sparrow Health
Peter Bow, Michigan Medicine
Kam Mirizzi, MPOG
Amit Bardia, MGH
Judy Negele, Trinity Health
Kate Buehler, MPOG
Bethany Pennington, WUSTL
Ruth Cassidy, MPOG
Meg Rolfzen, Michigan Medicine
Ettore Crimi, Atrium Health
Joseph Sanders, Henry Ford
Anna Dubovoy, Michigan Medicine
Rob Schonberger, Yale
Tony Edelman, MPOG
Nirav Shah, MPOG
Jackie Goatley, Michigan Medicine
Frances Guida Smiatacz, MPOG
Ashan Grewal, University of Maryland
Rachel Steinhorn, MGH
Jayakar Guruswamy, Henry Ford
David Sturmer, Michigan Medicine
Jerri Heiter, Trinity Health
Rachel Stumpf, MPOG
Allison Janda, MPOG
Adbul Tabbara, Henry Ford
Mark Korenke, Michigan Medicine
Meridith Wade, MPOG
Kayla Lopacki, Trinity Health
Andrew Zittleman, MPOG
Tiffany Malenfant, MPOG
Meeting Summary:
1. **Announcements**: Opening for a cardiac subcommittee vice-chair role (please reach
out to Allison Janda (ajanda@med.umich.edu) and Nirav Shah (nirshah@med.umich.edu)
if interested), seeking engagement from participants for measure reviews.
2. **ABX 03 Update**: Clarifications on the antibiotic redosing measure for cardiac
procedures were discussed, focusing on cases where surgery ends before the re-dose is
due but still within the window of success.
3. **BP 07 Cardiac Measure**: Proposed to focus on hypotension avoidance post-
induction but pre-incision. The group discussed incorporating a treatment element and
potentially excluding patients with baseline hypotension.
4. **Transfusion Measures**:
- **TRAN 05 Cardiac**: Monitoring of coagulation tests like TEG or ROTEM before
transfusions. Discussed expanding to include various coagulation tests and the feasibility
of mapping these tests across multiple sites.
- **TRAN 06 Cardiac**: The balanced transfusion measure (1:1:1 ratio) was considered
less appropriate for cardiac patients and not pursued further.
5. **Future Measures**: Discussion deferred to the next meeting, with plans for an
unblinded review of current measures.
The next meeting is scheduled for November, which includes unblinded reviews of
measures and requires registration.
Meeting Start: 1401
1. Agenda
a. Introduction & announcements
b. Measures Updates:
i. ABX-03-C: Antibiotic Re-dosing, Open Cardiac
c. Preliminary Data for New Measure:
i. BP-07-C: Hypothermia Avoidance, Induction, Open Cardiac (MAP < 55 mmHg)
ii. TRAN-05-C: Coagulation Monitoring
iii. TRAN-06-C: Balanced Transfusion
d. Summary and Next Steps
2. Introductions
a. ASPIRE Quality Team
i. Allison Janda, MD – MPOG Cardiac Anesthesia Subcommittee Lead
ii. Michael Mathis, MD – MPOG Director of Research
iii. Henrietta Addo, MSN, RN – Quality Improvement Specialist
b. Cardiac Anesthesiology Representatives joining us from around the US!
3. Seeking Cardiac Subcommittee Vice-Chair
a. 2 – year term
b. Help shape direction of Cardiac Subcommittee
c. Measure performance review, new measure development, measure revision
d. Identify and participate in research opportunities
e. Work with Allison, Henrie, and the MPOG team
f. Be able to devote 2 – 4 hours per month to this role
g. Cardiac Subcommittee Vice-Chair Description: here
h. 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
4. Measure Review Process
a. Review literature for given measure topic and provide review using MPOG Measure
Review Template
b. Present review of literature and recommendations at Cardiac Subcommittee meetings
c. Reviewers' names will be added to measure specifications as well as MPOG Measure
Reviewer website
5. 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
a. Thank you in advance for ensuring MPOG Cardiac-specific measures remain relevant &
consistent with published recommendations
b. Contact Allison with any questions: ajanda@med.umich.edu
6. Measure Updates:
1. ABX-03-C: Antibiotic Re-dosing, Open Cardiac
i. Description: Percentage of adult patients undergoing open cardiac surgery
with an antibiotic re-dose initiated within 3-4 hours after initial antibiotic
administration (cephalosporins only)
ii. Timing: 120 minutes prior to Anesthesia Start through Surgery End. If
Surgery End is not available, then Anesthesia End.
iii. Success Criteria: Documentation of cephalosporin re-dose within 165-255
minutes after each cephalosporin administration (max: 3 doses)
iv. Upcoming updates:
1. 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
Preliminary Measures
1. BP-07-C: Hypotension Avoidance (MAP < 55 mmHg), Induction, Open Cardiac
i. 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
ii. Timing: Anesthesia Start through Surgery Start
iii. Inclusions: Adult patients undergoing open cardiac procedures (determined
by Procedure Type: Cardiac value code:1)
iv. Success criteria: MAP < 55 mmHg that does not exceed cumulative time of 5
minutes throughout induction period until surgery start
v. Exclusions:
i. Age < 18
ii. ASA 6 including Organ Procurement (CPT:01990)
iii. 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)
iv. Lung transplants
vi. Discussion:
i. Any questions or comments with this specification?
1. Any additions to the exclusion criteria?
2. Expand threshold to 10 minutes instead of 5?
3. Anna Dubovoy (UMichigan): Is it possible to flag only if low
MAP was not treated?
4. Allison Janda (MPOG Cardiac Subcommittee Chair): We
would need to define treatment in order to enable this for
the measure.
5. Nirav Shah (MPOG Quality Director): If we can define
treatment, we can still flag those cases but add the
treatment modality as ‘additional information’ or details for
the results.
6. Rachel Steinhorn (Mass General): You mentioned that ASA 6
patients would be excluded but would we be able to
identify the ASA 4 or 5 patients who are emergency cases.
7. Kate Buehler (MPOG Coordinating Center): The dashboard
currently allows for filtering based on ASA or emergency
status for any measure.
8. Rob Schonberger (Yale): Consider adding BP-05 exclusion to
BP-07 for Baseline MAP<60.
9. Ashan Grewal (UMaryland): Including emergent cases with
the ability to exclude would be helpful.
10. Rachel Steinhorn (Mass General): Agreed, I think including
the emergent cases is good data to have, but having the
option to filter would be helpful.
11. Allison Janda (MPOG Cardiac Subcommittee Chair): What
does the group think about adding the exclusion for
Baseline MAP<60?
a. Ashan Grewal (UMaryland): Would still want to see
these cases included to know if we treated them
appropriately and if MAP improved throughout the
case.
b. Allison Janda (MPOG Cardiac Subcommittee Chair):
Can also modify the threshold to be <80% rather
than say, <90% also.
ii. VOTE:
2. TRAN-07-C: Coagulation Monitoring
i. Description: Percentage of adult patients undergoing open cardiac survey
who received transfusion and had a TEG or ROTEM checked with
administration of blood and/or blood components
ii. Timing: Anesthesia Start through Anesthesia End
iii. Inclusions: Adult patients undergoing open cardiac procedures (determined
by Procedure Type: Cardiac value code:1)
iv. Success criteria: TEG or ROTEM checked with administration of blood and
blood components
v. Exclusions:
i. Age < 18
ii. ASA including Organ Procurement (CPT:01990)
iii. Patients who did not receive a transfusion
vi. Transfusion defined as:
i. Packed Red Blood Cells
ii. Whole Blood
iii. Fresh Frozen Plasma
iv. Cryoprecipitate
v. Platelets
vi. Categorized Note – Blood Products
vii. Cases are excluded with only administration of autologous or
salvaged blood
viii. Cases are included if autologous or salvaged blood is administered
with any of the above transfusions
vii. Discussion
i. Any questions or comments with this specification?
1. Any ROTEM/TEG between anesthesia start and end or on
the day of surgery?
2. Considerations for how these labs are charted across all
sites
3. Anna Dubovoy (UMichigan): Is there a specific threshold for
number of PRBCs transfused before assessing for
ROTEM/TEG?
4. Allison Janda (MPOG Cardiac Subcommittee Chair): Great
point! What should our threshold be?
5. Mike Mathis (MPOG Research Director): How do we define
if it’s a discretionary transfusion vs. massive transfusion
requiring ROTEM/TEG? Perhaps the cutoff is defined as
<=3U PRBC = discretionary transfusion and >4U PRBC =
massive transfusion? Any non-PRBC unit should require
ROTEM/TEG assessed?
6. Anna Dubovoy (UMichigan): Maybe it’s okay to transfuse
PRBC without ROTEM but it’s not okay to do so when
transfusing FFP or platelets?
7. Allison Janda (MPOG Cardiac Anesthesia Subcommittee
Chair): Do we consider whole blood as PRBC or would it be
considered like platelets or FFP?
8. Mike Mathis (MPOG Research Director): Would recommend
we do whatever we do for the other quality measures…if
whole blood is considered as PRBC for those measures, do
the same for this measure. Also, would recommend this be
informational only.
9. Ashan Grewal (UMaryland): We may not be able to
participate with this measure fully as we don’t always have
this lab data come into the EHR in an automated fashion.
We use ROTEM routinely on every pump case, but it never
makes it into Epic.
ii. Vote:
3. TRAN-06-C: Balanced Transfusion
i. Description: Percentage of adult patients undergoing open cardiac surgery
who received transfusion and a 1:1:1 ratio of blood products was
administered
ii. Timing: Anesthesia Start through Anesthesia End
iii. Inclusions: Adult patients undergoing open cardiac procedures (determined
by Procedure Type: Cardiac value code:1)
iv. Success criteria: 1:1:1 ratio of blood cells to FFP to platelets were
administered
v. Questions/Concerns:
i. Is a 1:1:1 ratio clinically superior to a laboratory-driven transfusion
strategy?
ii. Rob Schonberger (Yale/MPOG Associate Research Director): I think
deviations make sense when they make sense
iii. Allison Janda (MPOG Cardiac Subcommittee Chair): I think this may
make sense in the trauma population to assess the ratio of blood
cells to FFP to platelets.
iv. Mike Mathis (MPOG Research Director): If you gave more than x
number of red cells, did you check coagulation and then give some
other product: platelets or FFP? Not sure it needs to be a 1:1:1 ratio
exactly. Would lean towards the first measure with ROTEM/TEG
testing.
v. Allison Janda (MPOG Cardiac Subcommittee Chair): Okay- looks like
there are a lot of ‘thumbs up’ and people agreeing with you, Mike.
Think we will just move forward without a vote on this – doesn’t
seem like there is a need to continue the build for this measure.
We’ll focus on the ROTEM/TEG evaluation measure instead.
Next Steps:
1. Open to all anesthesiologists or those interested in improving cardiothoracic
measures
a. Do not have to practice at an active MPOG institution
2. Meeting schedule:
a. June 2025
b. November 2025
3. Thank you for using the forum for discussion between meetings
Meeting adjourned: 1503
