Should Topical Ice Slush Be Used Routinely in Cardiac Surgery? Topical Ice Slush in Cardiac Surgery

TL;DR

This study examines whether using topical ice slush in cardiac surgery provides benefits or harms, finding no significant cardioprotective advantage and potential adverse effects.

Contribution

The study provides new evidence on the routine use of topical ice slush in cardiac surgery, suggesting it may not be necessary.

Findings

No significant cardioprotective benefit was found from using topical ice slush.

Intubation time was longer in patients who received topical ice slush.

Troponin T levels were higher in patients with topical ice slush on postoperative day 1.

Abstract

Background: The aim of this study is to investigate the effect of topical ice slush on cardiac protection in patients undergoing cardiac surgery and to analyze its potential side effects. Methods: Between 2023 and 2024, 890 patients who underwent cardiac surgery were evaluated. The patients were divided into two groups: Group A (n = 549), assigned ice slush(+), and Group B (n = 341), assigned ice slush(−). Echocardiographic findings, laboratory parameters, arterial blood gas findings, inotrope requirements, and postoperative outcomes were compared. Patients with a left internal thoracic artery were excluded from this study, and new subgroups were created as follows: Group C (n = 235), assigned ice slush(+), and Group D (n = 111), assigned ice slush(−). Chest radiography and diaphragm elevations (DEs) were compared at the 12-month follow-up. Results: No significant differences were found between the groups in terms of demographic characteristics, comorbidities, and operative data. The postoperative echocardiographic findings and ABG findings were similar. The inotrope requirement was higher in Group A. Postoperative day 1 Troponin T was higher in Group A than in Group B (median: 561–473 ng/mL, p = 0.01). The postoperative outcomes were similar between the groups, except that the intubation duration was longer in Group A. In the 1st postoperative week, 199 (36.2%) patients in Group A and 127 (37.2%) patients in Group B had DE. In the 12th month postoperation, 20 (3.6%) patients in Group A and 12 (3.5) patients in Group B had DE. Although not statistically significant, the incidence of DE was higher in Group C than in Group D in the early postoperative period only. Conclusions: We found no additional cardioprotective benefit from the use of topical ice slush in cardiac surgery. The intubation time was longer in patients with topical ice slush than in patients without it. Our results suggest that the routine use of topical ice slush in cardiac surgery is not necessary and that it has potential adverse effects.

Figures