title: Effects of albumin supplementation during cardioplegia administration: an in vitro analysis.
abstract: Increasing, the colloid osmotic pressure (COP) of blood cardioplegia (BCP) may reduce myocardial edema and preserve cardiac function following cardiopulmonary bypass (CPB). The purpose of this study was to quantify the effects of albumin (ALB) supplementation on cardioplegia COP through an in vitro analysis. A self-contained cardioplegia delivery system administered supplemental ALB to four BCP ratios (1:1, 4:1, 8:1, and 20:1). In Group A, 25% ALB was combined with BCP at four delivery rates (0, 13, 25, and 50 mL ALB/L BCP), with a delivery rate of 0 mL ALB/L BCP serving as the control for all groups. Twenty-five percent ALB was added to crystalloid to create carrier solutions containing 12.5, 25, or 50 g ALB/L in Group B, while Group C combined an ALB delivery rate of 50 mL ALB/L BCP with each of the three carrier solutions. End-points included initial and post-supplementation hematocrit, total serum protein (TSP), and COP. Without supplemental ALB, TSP was less affected with increasing blood to crystalloid ratios (1:1-81.7 +/- 6.2%, 4:1-40.6 +/- 5.1%, 8:1-20.6 +/- 4.1%, 20:1-6.0 +/- 5.7%). The TSP of 1:1 and 4:1 BCP increased (p < .0003 and p < .02) across all methods of supplementation, while 8:1 BCP was similarly increased (p < .008), except with 12.5 and 25 g ALB/L carrier solutions. The greatest change from baseline COP was seen with the lower blood to crystalloid ratios (1:1-64.3 +/- 5.0% and 4:1-39.5 +/- 10.5%). In higher ratios, the effects of dilution were less profound (14.6 +/- 4.2 +/- 4.2% and 20:1-6.0 +/- 1.9%). COP of 1:1 BCP increased (p < .008) whenever ALB was added. In conclusion, TSP and COP of blood cardioplegic solutions is increased by supplemental albumin administration with quantitative enhancement dependent upon the dilutional effects of the blood to crystalloid ratio.
authors.affiliation: Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska 68198-5155, USA. rebaccaahlgren@hotmail.com
authors.forename: Rebecca
authors.initials: R
authors.lastname: Knox
authors.forename: Alfred H
authors.initials: AH
authors.lastname: Stammers
authors.forename: Tunisia
authors.initials: T
authors.lastname: Ellis
authors.forename: Chen
authors.initials: C
authors.lastname: Gao
authors.forename: Bernadette
authors.initials: B
authors.lastname: Nutter
authors.forename: Hunter
authors.initials: H
authors.lastname: Holcomb
authors.forename: Ryan
authors.initials: R
authors.lastname: Schmer
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Hock
mesh_terms: D000418:Albumins / Q000008:administration & dosage*; D001798:Blood Proteins / Q000187:drug effects; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D004338:Drug Combinations; D016503:Drug Delivery Systems; D006400:Hematocrit; D066298:In Vitro Techniques; D009997:Osmotic Pressure / Q000187:drug effects; D017680:Potassium Compounds / Q000008:administration & dosage*; D014481:United States
chemical_list: D000418:Albumins; D001798:Blood Proteins; D002314:Cardioplegic Solutions; D004338:Drug Combinations; D017680:Potassium Compounds; C018369:potassium cardioplegic solution