title: [Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial].
abstract: OBJECTIVE
  Assess the effectiveness of priming the extracorporeal circulation system with albumin-mannitol combined with ultrafiltration during extracorporeal circulation to reduce post-operative bleeding and transfusion requirements in heart surgery, as well as its impact on the fluid balance, coagulation and hematocrit parameters, re-operation for bleeding, ICU, and hospital length of stay.
  
  
  METHODS
  A total of 134 patients scheduled for heart surgery were randomized to receive Ringer's lactate 1,500mL in the priming reservoir (group C), or mannitol 20% 250mL, albumin 20% 150mL and Ringer's lactate 1,100mL combined with ultrafiltration (group T). Bleeding volume, transfusions, fluid balance, coagulation, and hematology parameters were determined until 48h in the post-operative period.
  
  
  RESULTS
  There was a reduction of postoperative bleeding in group T, 1,165±789mL vs 992±662mL (P=.17), and red blood cell concentrate transfusions, 694±843mL vs 413±605mL (P=.03). Intra-operative and post-operative fluid balance was significantly less positive in group T, with an overall balance of 2,292±2,152mL vs 5,388±2,834mL (P<.001). There were higher values of hemoglobin and hematocrit, intraoperative (P<.001), on admission to ICU (P=.001), and at 6h (P=.05) in group T, and lower INR at 6h (P=.01) and 24h (P=.02). Re-operation rate and length of stay in ICU were higher in group C, but not statiscally significant.
  
  
  CONCLUSIONS
  The priming of extracorporeal reservoir with mannitol, albumin, and Ringer's lactate, combined with ultrafiltration, significantly improves intra- and post-operative fluid balance, resulting in a reduction in blood transfusions, with no significant decrease in post-operative bleeding, re-operation bleeding rate, and length of stay in the ICU.
authors.affiliation: Servicio de Anestesia-Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, España. Electronic address: miguelangel.olmosrodriguez@osakidetza.net.
authors.forename: M
authors.initials: M
authors.lastname: Olmos Rodríguez
authors.affiliation: Servicio de Anestesia-Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Ballester Hernández
authors.affiliation: Servicio de Anestesia-Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, España.
authors.forename: M T
authors.initials: MT
authors.lastname: Arteta Bárcenas
authors.affiliation: Servicio de Anestesia-Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, España.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez Cerezo
authors.affiliation: Servicio de Anestesia-Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Vidarte Ortiz de Artiñano
authors.affiliation: Servicio de Anestesia-Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, España.
authors.forename: C
authors.initials: C
authors.lastname: Veiga Alameda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000008:administration & dosage / Q000494:pharmacology*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000494:pharmacology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D000077325:Ringer's Lactate; D014148:Tranexamic Acid / Q000627:therapeutic use; D014462:Ultrafiltration; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: D000418:Albumins; D003102:Colloids; D000077324:Crystalloid Solutions; D006454:Hemoglobins; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D008353:Mannitol; D014148:Tranexamic Acid
keywords: Bleeding; Blood transfusion; Bypass cardiopulmonar; Cardiac surgery; Cardiopulmonary bypass; Cirugía cardiaca; Priming solution; Sangrado; Solución de cebado; Transfusión sanguínea; Ultrafiltración; Ultrafiltration