Albumin versus crystalloid prime solution for cardiopulmonary bypass in young children.
OBJECTIVE
To determine the effects of adding 5% albumin to the cardiopulmonary bypass prime on perioperative fluid status and fluid management in young children.


METHODS
Prospective randomized study.


METHODS
Single university hospital.


METHODS
Pediatric patients of <14 kg undergoing cardiac surgery requiring cardiopulmonary bypass.


METHODS
Patients received a 5% albumin prime or a crystalloid prime. Perioperative fluid intake, output, and daily weights were recorded. Serial hematocrits, colloid osmotic pressures, and serum albumins were measured. Outcomes and complications were documented.


RESULTS
There were 86 patients aged 3 days to 4 yrs; 44 patients had an albumin prime and 42 had a crystalloid prime. Patients in the albumin group had a net negative fluid balance at the end of cardiopulmonary bypass compared with a net positive fluid balance in the crystalloid group. Patients in the albumin group had significantly higher serum albumins and colloid osmotic pressures and gained less weight postoperatively. However, their hematocrits were lower, and more patients in the albumin group received packed red blood cells. By 24 hrs postoperatively, there were no differences in colloid osmotic pressures and hematocrits between groups, and by the fourth postoperative day, there was no difference in weight gain. No differences were found in length of mechanical ventilation, intensive care unit or hospital stay, complications, or mortality.


CONCLUSIONS
Albumin in the prime may attenuate the extravasation of fluid out of the vascular space, but it may be associated with an increased transfusion rate. The risk/benefit ratio for this intervention warrants further study.
Riegger
Lori Q
LQ
Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
Voepel-Lewis
Terri
T
Kulik
Thomas J
TJ
Malviya
Shobha
S
Tait
Alan R
AR
Mosca
Ralph S
RS
Bove
Edward L
EL
D000418:Albumins / Q000627:therapeutic use*; D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D003102:Colloids / Q000627:therapeutic use*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009997:Osmotic Pressure; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D015430:Weight Gain
D000418:Albumins; D003102:Colloids