Cardiothoracic surgery is a rapidly evolving specialty of medicine concerned with the management of multiple pathologies of organs within the thoracic cavity. At least two million cardiac surgeries are performed globally per annum, and this number continues to rise [1] . With an aging population, patients undergoing surgery are more likely to be older and possess more comorbidities such as diabetes and hypertension [2] . Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB)

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... ience systemic inflammation, resulting in post-operative complications and an increased risk of morbidity and mortality. Hence, therapeutic measures which limit the inflammatory response to cardiac surgery will improve surgical outcomes. This article will describe the inflammatory response which occurs following cardiac surgery performed on CPB and will review the use of alkaline phosphatase as a novel therapeutic measure to attenuate such. The Spectrum of Inflammation Inflammation is a normal, physiological response to tissue injury and insult [3]. This section will review the spectrum of inflammation, the molecular mediators of inflammation and describe how the use of CPB is associated with inflammation. The systemic inflammatory response syndrome (SIRS) describes a non-specific inflammatory cascade independent of the cause. It is often considered as an extension of the physiological immune response [4] . The clinical diagnosis of SIRs requires 2 or more of the following criteria as listed in Table 1 . Cardiac surgery is a well-established cause of SIRS. However, the proportion of patients which develop a florid SIRS following cardiac surgery is variable. All patients in Michalopoulos's 1996 study developed SIRS during the first 12 post-operative hours. In contrast, Squiccimarro et al. 2019 stated that 28.3% of their cohort developed SIRS after 24 hours, while Boehne et al. 2017 had