Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4 on coagulation and inflammatory response when used as priming solutions for cardiopulmonary bypass.
OBJECTIVE
This prospective, randomized and controlled trial compares the use of human albumin (HA) and hydroxyethyl starch (HES) 130/0.4 in the priming solution for a non-biocompatible cardiopulmonary bypass (CPB) circuit. The effects of each substance on coagulation, postoperative blood loss and pro-inflammatory activities were examined.


METHODS
Thirty-six adult patients undergoing mitral valvular heart surgery were randomly assigned to either the HA or HES group; 500 mL of 5% HA or 6% HES 130/0.4 were added to the priming solution of the CPB circuit for each group, respectively. Coagulation variables were measured perioperatively; these variables included thromboelastographic (TEG) parameters and pro-inflammatory markers such as interleukin (IL)-6, IL-8 and tumor necrotic factor (TNF)-a. Postoperative blood loss and transfusion requirements were also assessed.


RESULTS
There were no significant intergroup differences in the coagulation variables (including TEG parameters), serum concentrations of IL-6, IL-8 and TNF-a, and blood loss or transfusion requirements. TEG parameters, which indicate the speed of solid clot formation and the strength of the fibrin clot, decreased up to 4 hours after CPB in both groups. Serum concentrations of IL-6, IL-8 and TNF-a were higher up to 12 hours after surgery compared to baseline values in both groups. Hemoglobin levels and platelet counts were lower up to 12 hours after surgery compared to baseline values in both groups.


CONCLUSIONS
HES 130/0.4 was comparable to albumin as a component of the priming solution for a non-biocompatible CPB circuit. The two substances showed similar effects on coagulation variables, blood loss and pro-inflammatory activities in adult patients undergoing mitral valvular heart surgery.
Choi
Y S
YS
Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Shim
J K
JK
Hong
S W
SW
Kim
J C
JC
Kwak
Y L
YL
D001777:Blood Coagulation / Q000187:drug effects*; D002315:Cardiopulmonary Bypass; D005260:Female; D006023:Glycoproteins / Q000008:administration & dosage*; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007249:Inflammation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D010952:Plasma Substitutes / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D012709:Serum Albumin / Q000008:administration & dosage*; D000075462:Serum Albumin, Human
C422455:ALB protein, human; D006023:Glycoproteins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012709:Serum Albumin; D000075462:Serum Albumin, Human