Effects of intravascular volume therapy using hydroxyethyl starch (130/0.4) on post-operative bleeding and transfusion requirements in children undergoing cardiac surgery: a randomized clinical trial.
BACKGROUND
Hydroxyethyl starch (HES) used for intravascular volume expansion may cause coagulation abnormalities, especially in cardiac patients. Although low molecular weight HES (130/0.4) has been developed to minimize its influence on coagulation, experience with HES (130/0.4) in children is limited. Therefore, we evaluated the effects of a HES (130/0.4) infusion on post-operative blood loss in children undergoing cardiac surgery.


METHODS
Forty-two children undergoing cardiac surgery were assigned at random to receive either 10 ml/kg fresh frozen plasma (FFP group; n=21) or HES (130/0.4) (HES group; n=21) shortly after cardiopulmonary bypass termination. Activated partial thromboplastin time (aPTT) and international normalization ratio (INR) were measured. In addition, post-operative transfusion requirements and blood loss until the end of the first post-operative day were compared.


RESULTS
INR was significantly prolonged after HES infusion in comparison to the FFP group (P<0.05). During the first 24 h after surgery, post-operative blood loss, the use of allogenic blood/blood products and aPTT were similar in all children.


CONCLUSIONS
Our study shows that the administration of a moderate dose of HES (130/0.4) in children undergoing cardiac surgery does not cause more bleeding or a higher transfusion requirement than a FFP infusion, and suggests that the administration of 10 ml/kg HES (130/0.4) is a safe alternative to plasma for intravascular volume replacement in this patient population.
Chong Sung
K
K
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Kum Suk
P
P
Mi Ja
Y
Y
Kyoung Ok
K
K
D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007223:Infant; D019934:International Normalized Ratio; D008970:Molecular Weight; D010314:Partial Thromboplastin Time; D010949:Plasma; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000628:therapy*
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes