Does the use of a hot-shot lead to improved outcomes following adult cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Does the use of a 'hot-shot' (terminal warm blood cardioplegia) lead to improved outcomes following adult cardiac surgery? Altogether, 567 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that evidence supporting the use of a hot-shot prior to weaning from cardiopulmonary bypass is rather limited. All 8 of the randomized trials to date are small studies which examine heterogeneous groups of patients, and unfortunately, the conclusions are inconsistent, perhaps in part related to the inability to demonstrate statistical significance with small group size. From the evidence, it appears likely that the use of a hot-shot results in more rapid biochemical, electrical and possibly functional myocardial recovery from cardiopulmonary bypass. However, no study has been able to demonstrate that this leads to improved clinical outcomes other than lower incidence of atrial fibrillation.