title: Custom-tailored hemodilution with albumin and crystalloids in acute ischemic stroke.
abstract: OBJECTIVE
  Hemodilution in the acute phase of ischemic stroke is still controversial. Multicenter studies have failed to demonstrate any benefit. The present study focuses attention on analysis of circulation in stroke and on individual restabilization of circulation.
  
  
  METHODS
  The Amsterdam Stroke Study is a prospective, single-center, randomized clinical trial (n = 300). Normovolemic hemodilution is accomplished in a customized procedure by administration of 20% albumin plus crystalloids under hemodynamic and rheological monitoring in the acute phase of stroke. All patients receive general intensive care treatment and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy is guided on the basis of a target pulmonary capillary wedge pressure (12 +/- 3 mm Hg) and hematocrit (0.32 +/- 0.02). The control group receives only customized rehydration by infusion of crystalloids.
  
  
  RESULTS
  We obtained significant (p less than 0.05) reduction in mortality at 3 months (from 27% to 16%) and an increase in independence at home (from 35% to 48%) after viscosity reduction by means of hemodilution with albumin in the subgroup with a hematocrit less than 0.45 (n = 201) (specific viscosity effect). We also obtained a significant (p less than 0.005) reduction in mortality at 3 months (from 27% to 8%) and an increase in independence (from 35% to 59%) after only rehydration with crystalloids in the subgroup with overt dehydration (hematocrit greater than or equal to 0.45; n = 51) as compared with the normal-hematocrit group without signs of dehydration (hematocrit less than 0.45; n = 103) (specific rehydration effect).
  
  
  CONCLUSIONS
  This study may provide an explanation for the failures in former hemodilution trials and may re-establish proper hemodilution and rehydration as a valuable therapy in the acute phase of stroke, thus reducing mortality and improving independence after 3 months.
authors.affiliation: Department of Rheology, St. Lucas Hospital, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Goslinga
authors.forename: V
authors.initials: V
authors.lastname: Eijzenbach
authors.forename: J H
authors.initials: JH
authors.lastname: Heuvelmans
authors.forename: E
authors.initials: E
authors.lastname: van der Laan de Vries
authors.forename: V M
authors.initials: VM
authors.lastname: Melis
authors.forename: H
authors.initials: H
authors.lastname: Schmid-Schönbein
authors.forename: P D
authors.initials: PD
authors.lastname: Bezemer
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000097:blood / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000097:blood / Q000628:therapy*; D000077324:Crystalloid Solutions; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D007552:Isotonic Solutions; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D012709:Serum Albumin / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012709:Serum Albumin