title: The use of balanced HES 130/0.42 during complex cardiac surgery; effect on blood coagulation and fluid balance: a randomized controlled trial.
abstract: BACKGROUND
  Colloids and crystalloid are used during cardiac surgery for priming of the cardiopulmonary bypass (CPB) circuit. Colloids may decrease postoperative fluid balance because of their high oncotic pressure and low risk of fluid extravasation. On the other hand, colloids have been shown to impair blood coagulation.
  
  
  METHODS
  In a prospective, randomized, double-blinded study, 50 patients scheduled for coronary artery bypass grafting or a valve procedure were planned to be randomized to receive either balanced 6% HES130/0.42 or Ringer-acetate solution for CPB priming. Randomization was stopped prematurely after 35 randomized patients (19 in the HES and 16 in the Ringer groups) because of the published report where HES130/0.42 was associated with impaired renal function. Effects on haemostasis and fluid balance were investigated.
  
  
  RESULTS
  The rotational thromboelastometry (ROTEM®) parameters and chest tube drainage on the first postoperative morning (1POM) were comparable between the groups (p>0.05). However, patients in the HES group needed more blood and blood product transfusions. The total volume administered into the CPB circuit was lower in the HES than in the Ringer (RIN) group, 2905±1049 mL versus 3973±1207 mL (p=0.011), but there was no statistically significant difference in total fluid balance on the 1POM (5086±1660 mL in the HES group versus 5850±1514 mL in the RIN group, respectively).
  
  
  CONCLUSIONS
  After complex cardiac surgery, the use of balanced 6% HES130/0.42 solution for CPB circuit priming did not impair haemostasis measured by ROTEM®, but it increased the need for transfusions. Fluid balance after CPB was less positive in the HES group, but, on the 1POM, it was comparable between the groups.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland alexey.schramko@hus.fi.
authors.forename: A
authors.initials: A
authors.lastname: Schramko
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland.
authors.forename: R
authors.initials: R
authors.lastname: Suojaranta-Ylinen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Niemi
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Pesonen
authors.affiliation: Department of Intensive Care, Tampere University Hospital, Tampere, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Kuitunen
authors.affiliation: Department of Cardiothoracic Surgery, Helsinki University Hospital, Meilahti Hospital, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Raivio
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Salmenperä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects*; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D011182:Postoperative Care; D011446:Prospective Studies; D000077331:Ringer's Solution; D013916:Thrombelastography; D014882:Water-Electrolyte Balance / Q000187:drug effects*
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077331:Ringer's Solution
keywords: cardiac surgery; colloids; thromboelastometry